Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mason Boutwell

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1114753597

Mason Boutwell is a Student in an Organized Health Care Education/Training Program in Jackson, Mississippi. Practices as a sole proprietor. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

2500 N State St
Jackson, MS 39216-4500
Phone: (601) 270-3312
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1114753597
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 11, 2024
Last updated in NPPESSeptember 11, 2024
Certification dateSeptember 11, 2024
Mailing address2500 N State St, Jackson, MS 39216-4500

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