TENNESSEE PHS PC NPI 1063786648

NPI Information

  • NPI: 1063786648
  • Provider Name: TENNESSEE PHS PC
  • Classification: Nurse Practitioner - 363L00000X
  • Entity Type: Organization
  • Address: 950 W. BANNOCK STREET
    SUITE 1100
    BOISE, ID
    ZIP 83702
  • Phone: (877) 260-4747

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NPI Details

TENNESSEE PHS PC is a nurse practitioner in Boise, ID. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. TENNESSEE PHS PC NPI is 1063786648. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

950 W. BANNOCK STREET
SUITE 1100
BOISE, ID
ZIP 83702-140
Phone: (877) 260-4747
Fax: (901) 261-4867

The provider's authorized official is Nicole Howard .
The authorized official title is Cfo and has the following contact phone number (337) 991-9276.

The enumeration date for this NPI number is 2/29/2012 and was last updated on 7/2/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse PractitionerYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
120000842MEDICARE PINIDAHO
21063786648MEDICAIDIDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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