DR. JODIE LYNN BOLT MD NPI 1174596415

NPI Information

NPI: 1174596415
Provider Name: DR. JODIE LYNN BOLT, MD
Classification: Psychiatry & Neurology - 2084N0402X
Specialization: Neurology with Special Qualifications in Child Neurology
Entity Type: Individual
PECOS Registration: Yes
Address: 9040 JACKSON AVE MADIGAN ARMY MEDICAL CENTER
TACOMA, WA
ZIP 98431
Phone: (253) 968-1440

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NPI Details

DR. Jodie Lynn Bolt, MD is a neurology with special qualifications in child neurology psychiatry neurology in Tacoma, WA. The provider is a Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. DR. Jodie Lynn Bolt, MD NPI is 1174596415. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

9040 JACKSON AVE MADIGAN ARMY MEDICAL CENTER
TACOMA, WA
ZIP 98431-100
Phone: (253) 968-1440
Fax: (253) 968-0443

The NPI 1174596415 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/8/2006 and was last updated on 8/22/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084N0402X	Psychiatry & Neurology	Neurology with Special Qualifications in Child Neurology	0101045084	VIRGINIA	No
2	2084P0005X	Psychiatry & Neurology	Neurodevelopmental Disabilities	0101045084	VIRGINIA	No
3	2084P0005X	Psychiatry & Neurology	Neurodevelopmental Disabilities	MD00035673	WASHINGTON	No
4	2084N0402X	Psychiatry & Neurology	Neurology with Special Qualifications in Child Neurology	MD00035673	WASHINGTON	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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