Healthcare Provider Details

I. General information

NPI: 1013572973
Provider Name (Legal Business Name): JESSICA ROSE MCQUEARY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E LOUISE DR
MERIDIAN ID
83642-6304
US

IV. Provider business mailing address

3520 E LOUISE DR
MERIDIAN ID
83642-6304
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-0909
  • Fax: 208-888-5825
Mailing address:
  • Phone: 208-888-0909
  • Fax: 208-888-5825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number62505
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: