Provider Demographics
NPI:1922249713
Name:BOST, JENNIFER A (BS)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:A
Last Name:BOST
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 STATE HWY. VV
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-0071
Mailing Address - Country:US
Mailing Address - Phone:573-888-0642
Mailing Address - Fax:
Practice Address - Street 1:935 STATE HWY. VV
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-0071
Practice Address - Country:US
Practice Address - Phone:573-888-0642
Practice Address - Fax:573-888-1212
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator