Healthcare Provider Details

I. General information

NPI: 1225566292
Provider Name (Legal Business Name): JILLIAN ALEXA RIPPEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILLIAN ALEXA KOS

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E STATE ST STE 200
EAGLE ID
83616-6082
US

IV. Provider business mailing address

600 E STATE ST STE 200
EAGLE ID
83616-6082
US

V. Phone/Fax

Practice location:
  • Phone: 208-865-6401
  • Fax: 208-217-9213
Mailing address:
  • Phone: 208-856-6401
  • Fax: 208-217-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71512
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: