| Doctor Name: | LACEY MAE BOLDEN |
| NPI Number: | 1740410703 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | 14287 |
| Business Practice Address: | 5148a Murfreesboro Rd La Vergne, TN - 370862712 |
| Business Phone Number: | 6157933234 |
| Business Fax Number: | 6157932744 |
| Mailing Address: | 1020 N Highland Ave, Suite A MURFREESBORO |
| State: | TN |
| Postal Code: | 371302494 |
| Phone Number: | 6153966620 |
| Fax Number: | 6153966625 |
| NPI Enumeration Date: | 07/23/2009 |
| NPI Last Update Date: | 10/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 14287 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |