Healthcare Provider Details

I. General information

NPI: 1467356295
Provider Name (Legal Business Name): MATTHEW VAUGHN PRICE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E 2ND N
REXBURG ID
83440-1605
US

IV. Provider business mailing address

1920 E 200 N
REXBURG ID
83440-2901
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-5401
  • Fax:
Mailing address:
  • Phone: 208-313-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number60265
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: