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Individual

JEFFREY KARL BOSOLD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
APN

Contact information

Practice address
3812 WEST MAIN, RUSSELLVILLE, AR 72801
(479) 968-1245
(479) 968-4137
Mailing address
PO BOX 10185, RUSSELLVILLE, AR 72812-0185
(479) 968-5748
(479) 968-4137

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
A001909
AR
363LF0000X
Family Nurse Practitioner
Primary
A01909
AR

Other

Enumeration date
06/25/2007
Last updated
04/07/2020
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