MEDICARE: JAMES BOZEMAN PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11040567	FL

General Provider Information

NPI Number	:	1134004898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES BOZEMAN PMHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 5210
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58206-5210
Country	:	US
Telephone Number	:	701-205-3000
Fax Number	:	701-732-2501

Provider Business Practice Location Address
First Line	:	3674 S WASHINGTON ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201
Country	:	US
Telephone Number	:	701-205-3000
Fax Number	:	701-732-2501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	04/20/2026

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