Healthcare Provider Details

I. General information

NPI: 1043608458
Provider Name (Legal Business Name): JASON WRIGHT FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 158
COEUR D ALENE ID
83814-4404
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-5084
  • Fax:
Mailing address:
  • Phone: 208-625-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60547004
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number54815
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: