LARRY EDWARD BOLTON JR. (NPI# 1164684692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164684692 |
| Entity Type | Individual |
| Full Name | LARRY EDWARD BOLTON JR. |
| Credential | PA-C |
| Practice Address |
3000 S Ih 35 Ste 205 Austin TX 78704-6513 |
| Practice Telephone | 5129128200 |
| Practice Fax Number | 5129128206 |
| Mailing Telephone | 5129128200 |
| Mailing Fax Number | 5129128206 |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2008-06-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA 02475 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA 02475 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447303367 | Larry Taylor Bolton | Family Medicine | 303 Parks Ave, Scottsboro, AL 35768-2411 | 2007-01-22 |
| Street Address |
3000 S IH 35 STE 205 |
| City | AUSTIN |
| State | TX |
| Zip Code | 78704-6513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104977610 | Melanie Munk | Counselor | 3000 S Ih 35, Suite 315, Austin, TX 78704-6536 | 2007-01-13 |
| 1477705762 | John D Walker | Emergency Medicine | 3000 S Ih 35, Suite 330, Austin, TX 78704-6513 | 2008-10-17 |
| 1184888612 | Walter Flynn Buell | Psychiatry & Neurology | 3000 S Ih 35, Suite 330, Austin, TX 78704-6513 | 2008-07-14 |
| 1225299191 | William Mark Dewitt | Physician Assistant | 3000 S Ih 35, Suite 205, Austin, TX 78704 | 2008-06-23 |
| 1568622959 | Charles Hardy Gregory | Internal Medicine | 3000 S Ih 35, Suite 330, Austin, TX 78704-6513 | 2008-06-10 |
| 1497872493 | Kelly Leigh Pedersen | Counselor | 3000 S Ih 35, Suite 315, Austin, TX 78704-6513 | 2007-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801494018 | 340b Partners Pharmacy - Dallas LLC | Pharmacy | 2800 S Ih 35 Frontage Rd, Suite 105, Austin, TX 78704 | 2020-10-12 |
| 1740802206 | Roots, Aba Therapy and Consulting Services LLC | Behavioral Analyst | 3715 S. 1st St, #464, Austin, TX 78704 | 2020-05-07 |
| 1447896071 | Stefanie Van Hoose Mott | Nurse Practitioner | 2800 South Ih 35 Frontage Road #100, Austin, TX 78704 | 2019-11-19 |
| 1902463219 | Melanie Rabalais Lpc, Pllc | Counselor | 3111 Dickson Dr, Suite 33, Austin, TX 78704 | 2019-05-22 |
| 1023590866 | Roberto Carlos Guerra | Physical Therapy Assistant | 2515 S Ih 35, Ste 320, Austin, TX 78704 | 2018-08-29 |
| 1750875118 | Kristen Gabrielle Ferrante | Dentist | 2330 S Lamar Blvd, Austin, TX 78704 | 2018-06-19 |
| 1366944555 | Beryl Hoelscher | Registered Nurse | 706 W Ben White Blvd Ste 233a, Austin, TX 78704 | 2018-03-02 |
| 1780103861 | Remedy Pediatrics Pllc | Pediatrics | 2512 South Interstate 35 Frontage Rd., Suite 310, Austin, TX 78704 | 2017-09-11 |
| 1285176172 | Leah Nichole Burandt | Physician Assistant | 2512 S Interstate 35 Ste 310, Austin, TX 78704 | 2016-11-09 |
| 1659822690 | Kristin Jarrett | Physical Therapist | 1524 S I-35, Suite 300, Austin, TX 78704 | 2016-10-14 |
| Find all providers in zip 78704 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174123111 | Stephanie Rae Moench | Physician Assistant | 1704 Enfield Rd Apt 102, Austin, TX 78703-3348 | 2020-10-28 |
| 1376140400 | April L Thepsoumane | Physician Assistant | 4808 Hale Dr, Austin, TX 78749-3711 | 2020-10-01 |
| 1366050353 | Katherine Elizabeth Mankus | Physician Assistant | 12319 N Mopac Expy Ste 250, Austin, TX 78758-2499 | 2020-07-16 |
| 1629695044 | Brittany Ho | Physician Assistant | 12601 Scofield Farms Dr, Austin, TX 78727-4542 | 2020-07-01 |
| 1679197925 | Malia Scott | Physician Assistant | 2217 Park Bend Dr, Austin, TX 78758-5365 | 2020-06-02 |
| 1659992451 | Christopher Kent Brown | Physician Assistant | 2200 W 35th St Bldg 8, Austin, TX 78703-1222 | 2020-05-03 |
| 1982236550 | Stephen Young | Physician Assistant | 10001 S Ih 35 Ste 320, Austin, TX 78747-1705 | 2020-02-11 |
| 1528608908 | Megan Paige Sutphin | Physician Assistant | 1333 Shore District Dr Apt 1655, Austin, TX 78741-1317 | 2020-01-13 |
| 1235771403 | Central Ortho Assists Pllc | Physician Assistant | 501 Congress, Suite 150, Austin, TX 78701 | 2019-10-09 |
| 1619528569 | Lauren Michelle Feierstein | Physician Assistant | 4505 Duval St Apt 115, Austin, TX 78751-3225 | 2019-09-23 |
| Find all providers in AUSTIN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.