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General NPI Number Information
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NPI Number | 1497716476
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Entity Type | Individual
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Provider Name | STACEY KAY WRIGHT NP
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Gender | Female
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 5593 N GLENWOOD ST
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City | GARDEN CITY
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State | ID
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Zip | 83714
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Country | US
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Telephone | 208-322-5354
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Fax | 208-322-5379
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Provider Business Mailing Address
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Address Line | 3810 E HARDESTY ST
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City | BOISE
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State | ID
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Zip | 83716-5595
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Country | US
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Telephone | 208-631-0685
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Fax | 208-322-5379
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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 | 813271
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP539A
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License Number State | ID
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