Healthcare Provider Details

I. General information

NPI: 1588588685
Provider Name (Legal Business Name): JESSICA GILLET RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 HAYSTACK WAY
CALDWELL ID
83605-6981
US

IV. Provider business mailing address

4020 E JAMESTOWN DR
NAMPA ID
83686-6845
US

V. Phone/Fax

Practice location:
  • Phone: 208-454-4820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7271284
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: