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MR. CHARLES EDWARD BOULDIN R.P.T.
NPI 1679690101
Specialist in Tupelo, MS

Active since March 22, 2007Accepts Medicare Assignment
4749 S EASON BLVD, SUITE A, TUPELO, MS 38801(662) 842-3336(662) 842-3363 Get Directions Write a Review

NPPES record last updated: November 8, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Charles Edward Bouldin R.p.t. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. CHARLES EDWARD BOULDIN R.P.T. (NPI 1679690101) is an individual specialist in Tupelo, Mississippi, licensed in Mississippi (PT0198) and active in the NPI registry since March 2007. He is a graduate of Other (1976).

NPPES Registry Identity

NPI1679690101
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameMR. CHARLES EDWARD BOULDINCredential: R.P.T.
Location Address4749 S EASON BLVD, SUITE ATupelo, MS 38801-6547
Mailing Address4749 S Eason Blvd, Suite ATupelo, MS 38801-6547 · (662) 842-3336 · Fax (662) 842-3363
Phone(662) 842-3336
Fax(662) 842-3363
Sole ProprietorYes
Medical School CMSOtherGraduated 1976
Enumeration DateMarch 22, 2007
Last NPPES UpdateNovember 8, 2010
✔ NPI 1679690101 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in MS · PT0198
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
4749 S EASON BLVD, Tupelo, MS 38801
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Other Identifiers 1

Medicare ID-Type Unspecified650000011MS

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Charles Edward Bouldin R.p.t. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID345436689
PECOS Enrollment IDI20101129000171

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. BOBBIE G VANSLYKE FNP-BC, PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
4749 S EASON BLVD
TUPELO, MS 38801
Lee County (662) 350-0821

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charles Bouldin's NPI number?

The NPI number for Charles Bouldin is 1679690101. It was assigned to this individual provider in the NPPES registry on March 22, 2007.

Where is Charles Bouldin located?

Charles Bouldin practices at 4749 S Eason Blvd Suite A, Tupelo, MS 38801. The listed phone number is (662) 842-3336.

What is Charles Bouldin's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Charles Bouldin enrolled in Medicare?

Yes. Charles Bouldin is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Charles Bouldin accept?

Health plans from Molina Healthcare list Charles Bouldin as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Charles Bouldin was last updated on November 8, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.