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General NPI Number Information
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NPI Number | 1174807168
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Entity Type | Organization
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Legal Business Name | BOSWELL NUTRITION, PLLC
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Dates
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Enumeration Date | 10/08/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 400 NW 13TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-3711
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Country | US
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Telephone | 405-397-6999
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Fax | 405-563-9066
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Provider Business Mailing Address
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Address Line | 13900 STERLINGTON
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City | EDMOND
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State | OK
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Zip | 73013-7031
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Country | US
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Telephone | 405-397-6999
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Fax | 405-563-9066
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Authorized Official
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Title or Position | OWNER/DIETITIAN
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Name | MRS. KARA RAE BOSWELL
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Credential | MS, RD, LD
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Telephone | 405-397-6999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1778
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License Number State | OK
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