Healthcare Provider Details

I. General information

NPI: 1013763648
Provider Name (Legal Business Name): PRIORITY 1 HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 MAIN ST.
CASTLEFORD ID
83321
US

IV. Provider business mailing address

2479 E 3819 N
FILER ID
83328-5003
US

V. Phone/Fax

Practice location:
  • Phone: 208-358-0945
  • Fax: 208-733-9463
Mailing address:
  • Phone:
  • Fax: 208-733-9463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRANDI BARTHOLOMEW
Title or Position: OWNER
Credential: FNP
Phone: 205-358-0945