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General NPI Number Information
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NPI Number | 1558710889
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Entity Type | Individual
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Provider Name | CORY FRANKLIN BRISCOE APRN CRNA MSN
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Gender | Male
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 3648 S BOULDER CREEK LN
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City | AMMON
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State | ID
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Zip | 83406-5114
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Country | US
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Telephone | 208-201-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 3648 S BOULDER CREEK LN
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City | AMMON
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State | ID
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Zip | 83406-5114
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Country | US
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Telephone | 208-201-7088
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP9367780
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ARNP9367780
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License Number State | FL
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