Healthcare Provider Details

I. General information

NPI: 1790603298
Provider Name (Legal Business Name): BROOKLYNN DURANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 E PARK BLVD
BOISE ID
83712-7722
US

IV. Provider business mailing address

11726 MOSS LN
NAMPA ID
83651-8018
US

V. Phone/Fax

Practice location:
  • Phone: 208-972-5254
  • Fax:
Mailing address:
  • Phone: 208-501-4631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: