MISS MELISSA MARIE BOULDEN (NPI# 1336474717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336474717 |
| Entity Type | Individual |
| Full Name | MISS MELISSA MARIE BOULDEN |
| Credential | PA-C |
| Practice Address |
200 N Park St Kalamazoo MI 49007-3731 |
| Practice Telephone | 2693822500 |
| Practice Fax Number | 2693730123 |
| Mailing Telephone | 2693822500 |
| Mailing Fax Number | 2693730123 |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2014-10-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5601006202 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
2511-23 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS | 5390159 | 01 |
| Street Address |
200 N PARK ST |
| City | KALAMAZOO |
| State | MI |
| Zip Code | 49007-3731 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427051200 | Joseph Mirro Jr. | Pediatrics | 200 N Park St, West Michigan Cancer Center, Kalamazoo, MI 49007-3731 | 2005-05-24 |
| 1770105553 | Kathryn Barnett | Nurse Practitioner | 200 N Park St, Kalamazoo, MI 49007-3731 | 2020-05-14 |
| 1528618725 | Mallory Davis | Social Worker | 200 N Park St, Kalamazoo, MI 49007-3731 | 2019-09-19 |
| 1710498290 | Chelsea Ashcraft | Physician Assistant | 200 N Park St, Kalamazoo, MI 49007-3731 | 2017-10-24 |
| 1336650431 | Kaitlyn Mcgrail | Physician Assistant | 200 N Park St, Kalamazoo, MI 49007-3731 | 2017-10-16 |
| 1215394580 | Stephen Paul Rucker | Physician Assistant | 200 N Park St, Kalamazoo, MI 49007-3731 | 2016-01-18 |
| 1831566637 | Timothy Craig Nicaise Jr. | Nurse Practitioner | 200 N Park St, Kalamazoo, MI 49007-3731 | 2015-08-27 |
| 1730506510 | West Michigan Cancer Center | Pharmacy | 200 N Park St, Kalamazoo, MI 49007-3731 | 2014-03-18 |
| 1841624483 | Michael Thomas Francisco | Physician Assistant | 200 N Park St, Kalamazoo, MI 49007-3731 | 2013-08-31 |
| 1730463597 | Julie Ann Digiovanni | Clinical Nurse Specialist | 200 N Park St, Kalamazoo, MI 49007-3731 | 2011-09-28 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881248342 | Whitney Kiel | Pharmacist | 601 John Street Suite M-020, Kalamazoo, MI 49007 | 2019-08-01 |
| 1316591571 | Laura Jedele | Physical Therapist | Bronson Healthcare Group, 601 John St, Kalamazoo, MI 49007 | 2019-07-26 |
| 1992209084 | Yvonne Marie Heltzel | Behavior Technician | 1826 N Rose St, Kalamazoo, MI 49007 | 2018-03-22 |
| 1396263943 | Travis Todd Turrell | Physician Assistant | 125 S Kalamazoo Mall Suite 204, Kalamazoo, MI 49007 | 2017-09-05 |
| 1619493186 | Sarah Zuspann | Nurse Practitioner | 601 John Street, Suite 100, Kalamazoo, MI 49007 | 2017-08-16 |
| 1720529779 | Dannison | Psychologist | 604 S Rose St, Kalamazoo, MI 49007 | 2017-03-10 |
| 1265988901 | Calee Dieleman | Social Worker | 610 South Burdick, Kalamazoo, MI 49007 | 2016-09-01 |
| 1508313099 | Arriel Julia Ampey | Social Worker | 414 S. Burdick St., Suite 200, Kalamazoo, MI 49007 | 2016-09-01 |
| 1043662745 | Holloway Marston | Psychologist | 717 W South St, Apt. #6, Kalamazoo, MI 49007 | 2016-07-06 |
| 1205280062 | Bronson At Home | Home Health | 601 John St Ste M-431, Kalamazoo, MI 49007 | 2016-04-19 |
| Find all providers in zip 49007 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073057725 | Zachary Turk Harling | Physician Assistant | 2340 Waite Ave, Kalamazoo, MI 49008-1722 | 2016-12-15 |
| 1063961860 | Christine Murphy Lee | Physician Assistant | 6565 West Main St, Westside Family Medical Center, P.c, Kalamazoo, MI 49009 | 2016-09-22 |
| 1831470285 | Kalmazoo Gastroenterology Hepatology and Digestive Health Center | Physician Assistant | 1535 Gull Rd Ste 105, Kalamazoo, MI 49048-1630 | 2011-08-30 |
| 1922321322 | Lisa Marie Cotten | Physician Assistant | 4658 Silverleaf Ln, Kalamazoo, MI 49004-3179 | 2010-03-12 |
| 1043457534 | Carrie Ann Assenmacher | Physician Assistant | 1820 Shaffer Street, Kalamazoo, MI 49048-1604 | 2009-01-21 |
| 1801083126 | Jaclyn Frances Stoddard | Physician Assistant | 6565 West Main St., Kalamazoo, MI 49009 | 2007-10-01 |
| 1811085475 | James Bryon Newton | Physician Assistant | 4249 Pine Knoll Ave, Kalamazoo, MI 49004-9506 | 2006-10-10 |
| 1164490207 | William J Klerk Jr. | Physician Assistant | 1820 Shaffer St, Kalamazoo, MI 49048-1604 | 2006-03-14 |
| 1912999012 | Wayne Gerard Augustyniak | Physician Assistant | 2889 South 11th Street, Kalamazoo, MI 49009-2123 | 2005-08-16 |
| 1700880200 | Joseph Williams | Physician Assistant | 4613 W Main St, Ste. B, Kalamazoo, MI 49006-2645 | 2005-06-13 |
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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.