Healthcare Provider Details

I. General information

NPI: 1316288665
Provider Name (Legal Business Name): MICHAEL L PARSONS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 02/01/2022
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CHANNING WAY STE 306
IDAHO FALLS ID
83404-7546
US

IV. Provider business mailing address

PO BOX 741716
ATLANTA GA
30374-1716
US

V. Phone/Fax

Practice location:
  • Phone: 208-535-4400
  • Fax: 208-535-4404
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-1243A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1243A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: