Healthcare Provider Details

I. General information

NPI: 1043778624
Provider Name (Legal Business Name): REBEKAH G MYERS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBEKAH G RAGAN FNP-C

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 MAIN AVE
SAINT MARIES ID
83861-1238
US

IV. Provider business mailing address

PO BOX 449
SAINT MARIES ID
83861-0449
US

V. Phone/Fax

Practice location:
  • Phone: 208-568-7800
  • Fax: 208-568-7801
Mailing address:
  • Phone: 208-568-7800
  • Fax: 208-568-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60895
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: