MEDICARE: OMEGA MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP599A	ID

General Provider Information

NPI Number	:	1164427159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMEGA MENTAL HEALTH

Provider Business Mailing Address
First Line	:	8200 STEWART RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642
Country	:	US
Telephone Number	:	208-888-2319
Fax Number	:	208-288-2512

Provider Business Practice Location Address
First Line	:	5985 W. STATE ST.
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703
Country	:	US
Telephone Number	:	208-853-0071
Fax Number	:	208-853-9422

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTINA HARRINGTON
Credential	:	M.D.
Telephone Number	:	208-853-0071

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/22/2020

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Directions to “OMEGA MENTAL HEALTH ” Practice Location

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