Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kyle Bolton

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1861151326

Kyle Bolton is a Student in an Organized Health Care Education/Training Program in Fort Drum, New York. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
2

Practice location Address checks out

20460 Anaconda Rd
Fort Drum, NY 13603
Phone: (480) 387-0619
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Dietitian (primary) Taxonomy 133V00000X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1861151326
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedDecember 13, 2021
Last updated in NPPESMarch 18, 2025
Certification dateMarch 13, 2025
Mailing address20460 Anaconda Rd, Fort Drum, NY 13603

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