Healthcare Provider Details

I. General information

NPI: 1134053762
Provider Name (Legal Business Name): ELIZABETH COMPTON FCPSS, CPSS, YPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3452 W PARK CREEK DR
MERIDIAN ID
83642-4225
US

IV. Provider business mailing address

3452 W PARK CREEK DR
MERIDIAN ID
83642-4225
US

V. Phone/Fax

Practice location:
  • Phone: 208-841-4917
  • Fax:
Mailing address:
  • Phone: 208-841-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberZF384246D
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: