Healthcare Provider Details

I. General information

NPI: 1598622409
Provider Name (Legal Business Name): AB PSYCHIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 S 800 W
HEYBURN ID
83336-9758
US

IV. Provider business mailing address

472 S 800 W
HEYBURN ID
83336-9758
US

V. Phone/Fax

Practice location:
  • Phone: 208-430-2615
  • Fax:
Mailing address:
  • Phone: 208-430-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMY BISHOP
Title or Position: OWNER/PROVIDER PMHNP-BC
Credential: PMHNP-BC
Phone: 208-430-2615