Healthcare Provider Details

I. General information

NPI: 1023077765
Provider Name (Legal Business Name): BARBARA JANET BOSS CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 E FORTIFICATION ST
JACKSON MS
39202-2356
US

IV. Provider business mailing address

2500 N. STATE STREET
JACKSON MS
39216
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-8230
  • Fax: 601-354-6289
Mailing address:
  • Phone: 601-984-6270
  • Fax: 601-815-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR570451
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: