Healthcare Provider Details

I. General information

NPI: 1750077194
Provider Name (Legal Business Name): LANDON LLOYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 W ELDER ST STE 300
BOISE ID
83705-4986
US

IV. Provider business mailing address

1179 FIREBIRD CIR
TWIN FALLS ID
83301-3193
US

V. Phone/Fax

Practice location:
  • Phone: 208-286-1529
  • Fax: 208-445-2285
Mailing address:
  • Phone: 208-490-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: