Healthcare Provider Details

I. General information

NPI: 1033752498
Provider Name (Legal Business Name): SELAH WORLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 PLEASANT VLY RD
KUNA ID
83634-2709
US

IV. Provider business mailing address

PO BOX 190174
BOISE ID
83719-0174
US

V. Phone/Fax

Practice location:
  • Phone: 208-336-0740
  • Fax:
Mailing address:
  • Phone: 208-880-5635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number63076
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10190631
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: