Healthcare Provider Details

I. General information

NPI: 1609749522
Provider Name (Legal Business Name): LAUREN K SMITH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 W BUSINESS PARK LN
BOISE ID
83709-6797
US

IV. Provider business mailing address

48 E INDIAN CREEK RD
BOISE ID
83716-3410
US

V. Phone/Fax

Practice location:
  • Phone: 208-938-0081
  • Fax: 208-938-7741
Mailing address:
  • Phone: 260-271-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6171885
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: