Healthcare Provider Details

I. General information

NPI: 1083544266
Provider Name (Legal Business Name): ABIGAIL CARNLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 S. BRIDGE PL #150
EAGLE ID
83618
US

IV. Provider business mailing address

1800 N COLE RD APT B107
BOISE ID
83704-7378
US

V. Phone/Fax

Practice location:
  • Phone: 888-392-8642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26523097
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: