Healthcare Provider Details

I. General information

NPI: 1255291522
Provider Name (Legal Business Name): VALERIE KAY WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3422 S 15TH E
IDAHO FALLS ID
83404-8262
US

IV. Provider business mailing address

3422 S 15TH E
IDAHO FALLS ID
83404-8262
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-9292
  • Fax:
Mailing address:
  • Phone: 208-529-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number56921
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: