Provider Demographics
NPI:1629618608
Name:BOSWELL, MACY MELYSSA
Entity Type:Individual
Prefix:MS
First Name:MACY
Middle Name:MELYSSA
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 WESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73169-1431
Mailing Address - Country:US
Mailing Address - Phone:405-824-7157
Mailing Address - Fax:
Practice Address - Street 1:8105 WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73169-1431
Practice Address - Country:US
Practice Address - Phone:405-824-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator