Provider Demographics
NPI:1174596415
Name:BOLT, JODIE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JODIE
Middle Name:LYNN
Last Name:BOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-1440
Mailing Address - Fax:253-968-0443
Practice Address - Street 1:9040 JACKSON AVE MADIGAN ARMY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-1440
Practice Address - Fax:253-968-0443
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010450842084N0402X, 2084P0005X
WAMD000356732084P0005X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities