Healthcare Provider Details

I. General information

NPI: 1558620781
Provider Name (Legal Business Name): KANDISS L INMAN WHNP-BC, MSN, MSCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10280 W USTICK RD
BOISE ID
83704-5270
US

IV. Provider business mailing address

10280 W USTICK RD
BOISE ID
83704-5270
US

V. Phone/Fax

Practice location:
  • Phone: 208-780-9295
  • Fax: 855-490-9559
Mailing address:
  • Phone: 208-780-9295
  • Fax: 855-490-9559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN-38712
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNP-1050A
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNUR-APRN-LIC-238567
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP-1050A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: