Provider Demographics
NPI:1023077765
Name:BOSS, BARBARA JANET (CFNP)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JANET
Last Name:BOSS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N. STATE STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-984-6270
Mailing Address - Fax:601-815-1828
Practice Address - Street 1:258 E FORTIFICATION ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2356
Practice Address - Country:US
Practice Address - Phone:601-815-8230
Practice Address - Fax:601-354-6289
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCR570451363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119044Medicaid
MS355987YJ5DMedicare PIN
MSS61020Medicare UPIN
MS500000360Medicare ID - Type Unspecified