Healthcare Provider Details

I. General information

NPI: 1568378958
Provider Name (Legal Business Name): AMBER ESTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3597 E MONARCH SKY LN STE 240
MERIDIAN ID
83646-1055
US

IV. Provider business mailing address

66 AYERS RD
ARAGON GA
30104-1858
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-6264
  • Fax:
Mailing address:
  • Phone: 770-324-4302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8981520
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: