Healthcare Provider Details

I. General information

NPI: 1295393965
Provider Name (Legal Business Name): EMILY MARIA BOSHELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST STE 4G SUITE 1140
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

716 FOX BEND TRL
EDMOND OK
73034-7355
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5789
  • Fax: 405-271-1643
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3087
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: