Healthcare Provider Details

I. General information

NPI: 1992306344
Provider Name (Legal Business Name): EMILY JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY HERRMANN

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 N LIBERTY ST STE 300
BOISE ID
83704-8708
US

IV. Provider business mailing address

3340 E GOLDSTONE DR
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-2300
  • Fax: 208-302-2355
Mailing address:
  • Phone: 208-302-9342
  • Fax: 208-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202078
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2301
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: