Healthcare Provider Details

I. General information

NPI: 1407319841
Provider Name (Legal Business Name): JESSICA ANN HARNISCH-BOYD DO, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 COMMERCE DRIVE
SMELTERVILLE ID
83868
US

IV. Provider business mailing address

201 N BRUCE DR
COEUR D ALENE ID
83814-5801
US

V. Phone/Fax

Practice location:
  • Phone: 208-784-4612
  • Fax:
Mailing address:
  • Phone: 208-784-8765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-1429
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: