Healthcare Provider Details

I. General information

NPI: 1336027754
Provider Name (Legal Business Name): SIERRA WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 W USTICK RD STE 110
MERIDIAN ID
83646-7740
US

IV. Provider business mailing address

1510 W USTICK RD STE 110
MERIDIAN ID
83646-7740
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-0929
  • Fax: 208-906-8236
Mailing address:
  • Phone: 208-934-0929
  • Fax: 208-906-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. TALIA SIERRA
Title or Position: OWNER
Credential: PA-C
Phone: 208-934-0929