Provider Demographics
NPI:1073144333
Name:HU, BOQIN (FNP)
Entity Type:Individual
Prefix:
First Name:BOQIN
Middle Name:
Last Name:HU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14060 OLD AVERA RD
Mailing Address - Street 2:
Mailing Address - City:STATE LINE
Mailing Address - State:MS
Mailing Address - Zip Code:39362-7112
Mailing Address - Country:US
Mailing Address - Phone:601-381-7218
Mailing Address - Fax:
Practice Address - Street 1:3446 BIG RIDGE RD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2421
Practice Address - Country:US
Practice Address - Phone:228-386-1185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903772363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care