Provider Demographics
NPI:1225761612
Name:BOSWELL, JASMINE C (BSC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:C
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 W MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-5325
Mailing Address - Country:US
Mailing Address - Phone:580-747-7187
Mailing Address - Fax:
Practice Address - Street 1:729 E MAINE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5915
Practice Address - Country:US
Practice Address - Phone:580-237-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management