Provider Demographics
NPI:1689274912
Name:BOSLEY, COLLEEN ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-9780
Mailing Address - Country:US
Mailing Address - Phone:270-358-6221
Mailing Address - Fax:270-358-6569
Practice Address - Street 1:113 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-9780
Practice Address - Country:US
Practice Address - Phone:270-358-6221
Practice Address - Fax:270-358-6569
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015280363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health