Healthcare Provider Details

I. General information

NPI: 1740012145
Provider Name (Legal Business Name): ASHLEY WINEGAR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E 2ND N
REXBURG ID
83440-1605
US

IV. Provider business mailing address

1814 E 200 N
REXBURG ID
83440-2912
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-5401
  • Fax:
Mailing address:
  • Phone: 307-212-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2261172
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: