Boutwell, Jesse Allan
Boutwell, Jesse Allan is an individual health care provider with primary practice located at 1050 State Highway 16 S , Bandera TX 78003-4830. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Boutwell, Jesse Allan can be contacted via phone (830) 261-0684.Contact Information
Primary practice address
1050 State Highway 16 S
Bandera TX 78003-4830
Phone: (830) 261-0684
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA00055 | Texas |
Profile Details
| NPI number | 1912977117 |
|---|---|
| LBN Legal business name | Boutwell, Jesse Allan |
| Credentials | PHYSICIAN ASSISTANT |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 23rd, 2006 |
| Last updated | Oct 17th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912977117 | NPPES |
| Other | Z142263 | PTAN |
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