Healthcare Provider Details

I. General information

NPI: 1649181876
Provider Name (Legal Business Name): BRITTANY HARDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S ORCHARD ST STE 110
BOISE ID
83705-1961
US

IV. Provider business mailing address

10408 W IRVING CT
BOISE ID
83704-8051
US

V. Phone/Fax

Practice location:
  • Phone: 208-495-5639
  • Fax: 208-506-7865
Mailing address:
  • Phone: 208-495-5639
  • Fax: 208-506-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberHB190503B
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: