Provider Demographics
NPI:1700323466
Name:BOSWORTH, AUDREY DANIELLE (APRN)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:DANIELLE
Last Name:BOSWORTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:DANIELLE
Other - Last Name:CORRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:918-542-3900
Mailing Address - Fax:918-542-3928
Practice Address - Street 1:21 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6815
Practice Address - Country:US
Practice Address - Phone:918-542-3900
Practice Address - Fax:918-542-3928
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017001327363L00000X
OK134481363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner