Provider Demographics
NPI:1104175736
Name:BOSWELL, CHRISTY DAWN (APRN)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:DAWN
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:DAWN
Other - Last Name:BOSWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1387W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-9766
Mailing Address - Country:US
Mailing Address - Phone:918-453-5554
Mailing Address - Fax:918-431-4112
Practice Address - Street 1:100 S. BLISS AVENUE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-458-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily