MEDICARE: TYSON FLOWER FNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	53465	ID

General Provider Information

NPI Number	:	1184258311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYSON FLOWER FNP

Provider Business Mailing Address
First Line	:	3295 W ELDER ST STE 117
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83705-4771
Country	:	US
Telephone Number	:	208-992-4086
Fax Number	:	208-210-1936

Provider Business Practice Location Address
First Line	:	3295 W ELDER ST STE 117
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83705-4771
Country	:	US
Telephone Number	:	208-992-4086
Fax Number	:	208-210-1936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2020
Last Update Date	:	09/16/2025

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