Tennessee Phs PC

NPI #1063786648 in Boise, Idaho

Provider Information

NPI Number: 1063786648
Entity Type: Organization
Organization Name: Tennessee Phs PC
Subpart: Yes (part of a larger organization)
Parent Organization: PROVIDER HEALTH SERVICES LLC
Primary Specialty: Nurse Practitioner
Enumeration Date: Feb 29, 2012
Last Updated: Jul 2, 2014

Practice Location

Address: 950 W. BANNOCK STREET
Address 2: SUITE 1100
City: Boise
State: Idaho
ZIP Code: 83702-6140
Phone: (877) 260-4747

Authorized Official

Name: NICOLE HOWARD
Title: CFO
Phone: (337) 991-9276

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner	363L00000X	Primary

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