Healthcare Provider Details

I. General information

NPI: 1003312489
Provider Name (Legal Business Name): ADRIANN J WILCOX FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIANN JEPPESEN

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E 2ND N
REXBURG ID
83440-1605
US

IV. Provider business mailing address

393 E 2ND N
REXBURG ID
83440-1605
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-5401
  • Fax: 208-356-3111
Mailing address:
  • Phone: 208-356-5401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4032574
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number58219
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: