Healthcare Provider Details

I. General information

NPI: 1184567091
Provider Name (Legal Business Name): JENNIFER NESBITT PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER HOOLEHAN

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 E LANARK DR
MERIDIAN ID
83642-5982
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-4400
  • Fax: 208-377-4416
Mailing address:
  • Phone: 208-955-6500
  • Fax: 208-955-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number58871710
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5881710
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.542425
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: