Healthcare Provider Details

I. General information

NPI: 1558710889
Provider Name (Legal Business Name): CORY FRANKLIN BRISCOE APRN CRNA MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CORY BRISCOE APRN CRNA

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3648 S BOULDER CREEK LN
AMMON ID
83406-5114
US

IV. Provider business mailing address

3648 S BOULDER CREEK LN
AMMON ID
83406-5114
US

V. Phone/Fax

Practice location:
  • Phone: 208-201-7088
  • Fax:
Mailing address:
  • Phone: 208-201-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9367780
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberARNP9367780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: