MEDICARE: STACEY KAY WRIGHT NP

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	813271	NV
2	363LF0000X	Family Nurse Practitioner	NP539A	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497716476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY KAY WRIGHT NP

Provider Business Mailing Address
First Line	:	3810 E HARDESTY ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83716-5595
Country	:	US
Telephone Number	:	208-631-0685
Fax Number	:	208-322-5379

Provider Business Practice Location Address
First Line	:	5593 N GLENWOOD ST
Second Line	:
City	:	GARDEN CITY
State	:	ID
Zip	:	83714
Country	:	US
Telephone Number	:	208-322-5354
Fax Number	:	208-322-5379

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	03/07/2023

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