Healthcare Provider Details

I. General information

NPI: 1144193012
Provider Name (Legal Business Name): ABBIE L BROOKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E IDAHO ST STE 200
BOISE ID
83712-6270
US

IV. Provider business mailing address

100 E IDAHO ST STE 200
BOISE ID
83712-6270
US

V. Phone/Fax

Practice location:
  • Phone: 208-345-6545
  • Fax:
Mailing address:
  • Phone: 208-345-6545
  • Fax: 208-345-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3171486
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: