Healthcare Provider Details

I. General information

NPI: 1427109024
Provider Name (Legal Business Name): AMY NICOLE BOSWELL BA PRIMARY SERVICE C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 S MAIN ST STE B
LEITCHFIELD KY
42754-1056
US

IV. Provider business mailing address

635 S MAIN ST STE B
LEITCHFIELD KY
42754-1056
US

V. Phone/Fax

Practice location:
  • Phone: 270-287-0656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number262626
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: