Provider Demographics
NPI:1730188285
Name:BOSWELL, JOLENE H (PA-C)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:H
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 SHELBYVILLE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3398
Mailing Address - Country:US
Mailing Address - Phone:502-897-7546
Mailing Address - Fax:502-897-7055
Practice Address - Street 1:4600 SHELBYVILLE RD STE 220
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3398
Practice Address - Country:US
Practice Address - Phone:502-897-7546
Practice Address - Fax:502-897-7055
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY139207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0098611Medicare ID - Type Unspecified
P9385Medicare UPIN