Healthcare Provider Details

I. General information

NPI: 1508552829
Provider Name (Legal Business Name): RACHAEL EVE SMITH PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 S KIMBALL AVE
CALDWELL ID
83605-4547
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-505-2950
  • Fax: 208-505-2955
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNUR-APRN-LIC-214478
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2661878
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: