Individual
MS. JENNIFER BOOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3089 S LIBERTY ST, CANTON, MS 39046-9224
(601) 813-5249
Mailing address
720 KING RANCH RD, CANTON, MS 39046-2912
(662) 751-8847
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R869554
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R869554
STATE LICENSE NUMBER
MS
Enumeration date
10/14/2014
Last updated
03/22/2019
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