Mrs Willie Mary Bolden, in Shaw, MS - Medicare Nurse Practitioner

Mrs Willie Mary Bolden, is a medicare enrolled "Nurse Practitioner - Family" in Shaw, Mississippi. She graduated from nursing school in 2018 and has 6 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Fast Pace Mississippi Pllc and her current practice location is 112 W Peeler Ave, Shaw, Mississippi. You can reach out to her office (for appointments etc.) via phone at (662) 745-6638.

Mrs Willie Mary Bolden is licensed to practice in Mississippi (license number 903205) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1518428283.

Contact Information

	Mrs Willie Mary Bolden,
	112 W Peeler Ave, Shaw, MS 38773-8710
	(662) 745-6638
	Not Available

Map and Direction

Provider's Profile

Full Name	Mrs Willie Mary Bolden
Gender	Female
Speciality	Nurse Practitioner
Experience	6 Years
Location	112 W Peeler Ave, Shaw, Mississippi
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Mrs Willie Mary Bolden graduated from nursing school in 2018

NPI Data:

NPI Number: 1518428283
Provider Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019

Medicare PECOS Information:

PECOS PAC ID: 4587994181
Enrollment ID: I20190925000170

Medical Identifiers

Medical identifiers for Mrs Willie Mary Bolden such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1518428283	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	903205 (Mississippi)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Fast Pace Mississippi Pllc	3678832029	136

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Willie Mary Bolden allows following entities to bill medicare on her behalf.

Entity Name	Delta Medical Group
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1790701134 PECOS PAC ID: 6608775531 Enrollment ID: O20040108000636

Entity Name	Shaw Family Medical, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1750642633 PECOS PAC ID: 3072769843 Enrollment ID: O20120809000742

Entity Name	Fast Pace Mississippi Pllc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1447769559 PECOS PAC ID: 3678832029 Enrollment ID: O20180111000291

Entity Name	Making Moves In The Community Incorporated
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1851884266 PECOS PAC ID: 4284038738 Enrollment ID: O20210806000017

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Willie Mary Bolden is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mrs Willie Mary Bolden, 112 W Peeler Ave, Shaw, MS 38773-8710 Ph: (662) 754-3301	Mrs Willie Mary Bolden, 112 W Peeler Ave, Shaw, MS 38773-8710 Ph: (662) 745-6638

Reviews and Comments

Nurse Practitioner Nurses in Shaw, MS

Teresa Wilson, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 112 W Peeler Ave, Shaw, MS 38773 Phone: 662-754-3301
Tiffany Sherell Newell, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 112 W Peeler Ave, Shaw, MS 38773 Phone: 662-754-3301
Mrs. Sereka V Walker, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 112 W Peeler Ave, Shaw, MS 38773 Phone: 662-754-3301 Fax: 662-754-3304
Mrs. Regina Jonelle Evans, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 112 W Peeler Ave, Shaw, MS 38773 Phone: 662-754-3301 Fax: 662-754-3304
Nora Cecelia Gough-davis, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 112 W Peeler Ave, Shaw, MS 38773 Phone: 662-754-3301 Fax: 662-754-3304
Dametra Mangum, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 112 W Peeler Ave, Shaw, MS 38773 Phone: 662-754-3301

Mrs Willie Mary Bolden, - Medicare Nurse Practitioner in Shaw, MS