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General NPI Number Information
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NPI Number | 1083038335
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Entity Type | Individual
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Provider Name | JAN REHDER KING FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 2867 E COPPER POINT DR
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City | MERIDIAN
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State | ID
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Zip | 83642-1716
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Country | US
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Telephone | 208-401-9100
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Fax | 208-401-9150
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Provider Business Mailing Address
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Address Line | 5333 N BROOKMEADOW WAY
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City | BOISE
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State | ID
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Zip | 83713-1480
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Country | US
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Telephone | 208-866-5333
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Fax | 769-206-4683
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-1404A
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License Number State | ID
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