Provider Demographics
NPI:1790368231
Name:BOSWELL, BRENDA KAY (FNP-C)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ARBUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-5736
Mailing Address - Country:US
Mailing Address - Phone:731-664-0103
Mailing Address - Fax:
Practice Address - Street 1:1270 UNION UNIVERSITY DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3856
Practice Address - Country:US
Practice Address - Phone:731-664-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily