Individual
MRS. JENNIFER R BOUTWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
303 MARION AVE, MCCOMB, MS 39648-2707
(601) 249-1350
(601) 249-1339
Mailing address
303 MARION AVE, MCCOMB, MS 39648-2707
(601) 249-1350
(601) 249-1339
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R880925
MS
Other
Enumeration date
09/25/2009
Last updated
09/25/2009
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