Healthcare Provider Details

I. General information

NPI: 1902491467
Provider Name (Legal Business Name): YELLOW DAISY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 E 4TH N STE 233
REXBURG ID
83440-6009
US

IV. Provider business mailing address

343 E 4TH N STE 233
REXBURG ID
83440-6009
US

V. Phone/Fax

Practice location:
  • Phone: 208-715-6709
  • Fax:
Mailing address:
  • Phone: 208-715-6709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNA BLONQUIST
Title or Position: MANAGER
Credential: BCNP-PMHNP
Phone: 208-715-6709