Healthcare Provider Details

I. General information

NPI: 1164347456
Provider Name (Legal Business Name): WELLBERRY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S WOODRUFF AVE
IDAHO FALLS ID
83401-4322
US

IV. Provider business mailing address

333 S WOODRUFF AVE
IDAHO FALLS ID
83401-4322
US

V. Phone/Fax

Practice location:
  • Phone: 208-413-7917
  • Fax: 208-218-0845
Mailing address:
  • Phone: 208-413-7917
  • Fax: 208-218-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW RYAN BRADBURY
Title or Position: PHYSICIAN
Credential: MD
Phone: 208-413-7917