Healthcare Provider Details

I. General information

NPI: 1942485180
Provider Name (Legal Business Name): KARA DELACY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N STILSON RD STE 300
BOISE ID
83703-5145
US

IV. Provider business mailing address

801 N STILSON RD STE 300
BOISE ID
83703-5145
US

V. Phone/Fax

Practice location:
  • Phone: 208-332-4540
  • Fax:
Mailing address:
  • Phone: 208-332-4540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN-32262
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-887A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: