Healthcare Provider Details

I. General information

NPI: 1720432230
Provider Name (Legal Business Name): CHANTELL WILLIAMS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 LAKE CASCADE PKWY
CASCADE ID
83611-7702
US

IV. Provider business mailing address

PO BOX 1330
CASCADE ID
83611-1330
US

V. Phone/Fax

Practice location:
  • Phone: 208-382-4285
  • Fax:
Mailing address:
  • Phone: 208-382-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-1732A
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1732A
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1026308
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10057664
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: