Healthcare Provider Details

I. General information

NPI: 1518762574
Provider Name (Legal Business Name): AUSTIN WOOLARD NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH STREET
LEWISTON ID
83501-2434
US

IV. Provider business mailing address

415 6TH ST
LEWISTON ID
83501-2434
US

V. Phone/Fax

Practice location:
  • Phone: 208-799-5226
  • Fax: 208-799-5798
Mailing address:
  • Phone: 208-750-7462
  • Fax: 208-750-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4871146
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4871146
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: