Healthcare Provider Details

I. General information

NPI: 1215362785
Provider Name (Legal Business Name): HEATHER ANN WILCKE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ANN JOHNSON NA

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 W ORCHARD AVE
NAMPA ID
83651-1878
US

IV. Provider business mailing address

6933 W EMERALD ST
BOISE ID
83704-8616
US

V. Phone/Fax

Practice location:
  • Phone: 208-461-2838
  • Fax: 208-461-5099
Mailing address:
  • Phone: 208-361-0634
  • Fax: 208-321-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-1342A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: