MEDICARE: BEE HAPPY PEDIATRICS

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	363LP0200X	Pediatric Nurse Practitioner	57138	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	:	1790291276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEE HAPPY PEDIATRICS

Provider Business Mailing Address
First Line	:	3412 S 25TH E
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-4967
Country	:	US
Telephone Number	:	208-497-0680
Fax Number	:	208-497-0650

Provider Business Practice Location Address
First Line	:	3412 S 25TH E
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-4967
Country	:	US
Telephone Number	:	208-497-0680
Fax Number	:	208-497-0650

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	DEBORAH A HILL
Credential	:	CPNP
Telephone Number	:	208-497-0680

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	01/19/2021

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Directions to “BEE HAPPY PEDIATRICS ” Practice Location

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