IndividualActive
Richard Boleware, CP
NPI 1194909069 · Prosthetist · Jackson, MS
Provider details
- NPI number
- 1194909069
- Entity type
- Individual
- Primary specialty
- ProsthetistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- CP
- Sex
- Male
- Sole proprietor
- No
- License
- CP003226 (MS)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
2 Old River Pl Ste D
Jackson, MS 39202-3435
Phone: (601) 944-1130
Fax: (601) 355-7476
Approximate (ZIP-level) locationGet directions
Mailing address
2 Old River Pl Ste D
Jackson, MS 39202-3435
Registry dates
- Enumerated
- 2007-12-27
- Last updated
- 2015-05-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.