Provider Demographics
NPI:1851050413
Name:BOSWELL, CANDACE MICHELLE
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:MICHELLE
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 1:10800 FINANCIAL CENTRE PKWY STE 290
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3581
Mailing Address - Country:US
Mailing Address - Phone:870-340-2636
Mailing Address - Fax:888-816-7916
Practice Address - Street 1:702 N MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2920
Practice Address - Country:US
Practice Address - Phone:870-340-2636
Practice Address - Fax:833-226-0134
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator