Individual
NICHOLAS BOSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1815 HOWARD ST, JACKSON, MS 39202-1326
(662) 719-6425
Mailing address
1815 HOWARD ST, JACKSON, MS 39202-1326
(662) 719-6425
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/14/2021
Last updated
05/16/2021
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