Healthcare Provider Details

I. General information

NPI: 1972496834
Provider Name (Legal Business Name): ELAINA SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 RIGBY LAKE DR STE 1500
RIGBY ID
83442-5374
US

IV. Provider business mailing address

850 W 5000 S
REXBURG ID
83440-4314
US

V. Phone/Fax

Practice location:
  • Phone: 208-745-5021
  • Fax:
Mailing address:
  • Phone: 208-201-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9271266
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: