Provider Demographics
NPI:1568926343
Name:BOSWELL, BRANDON SCOTT (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:SCOTT
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 RUBY DR
Mailing Address - Street 2:
Mailing Address - City:BROCK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-5929
Mailing Address - Country:US
Mailing Address - Phone:682-478-9752
Mailing Address - Fax:
Practice Address - Street 1:2517 HIGHWAY 180 W STE A
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-8297
Practice Address - Country:US
Practice Address - Phone:940-325-3706
Practice Address - Fax:940-325-6200
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily