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Lacey Mae Bolden

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

This provider is enrolled in PECOS as LACEY BOLDEN.

Based on the most recent information from CMS, provider Lacey Mae Bolden is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1740410703
Provider Type
Individual
Full Name
Bolden, Lacey Mae
Credential
APN

Gender
Female
Sole Proprietor
No
Enumeration Date
7/23/2009
Last Updated
3/21/2024

Contact Information

Practice Location

926 Main St, Nashville, TN 37206-3614

(615) 679-9087

Unlisted Fax

Mailing Location

2204 Salem Woods Dr, Rockvale, TN 37153-4178

(931) 334-6507

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 14287 Tennessee

Lacey Mae Bolden

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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