Healthcare Provider Details

I. General information

NPI: 1619385119
Provider Name (Legal Business Name): JESSICA M HERR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MARIE TERRY

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8854 W EMERALD ST STE 260
BOISE ID
83704-4860
US

IV. Provider business mailing address

3340 E GOLDSTONE DR
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-755-2804
  • Fax: 208-765-0277
Mailing address:
  • Phone: 208-302-4600
  • Fax: 208-302-4655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60495206
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60495206
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60495206
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-1690A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: