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General NPI Number Information
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NPI Number | 1720502370
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Entity Type | Organization
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Legal Business Name | VISTA HEALTHCARE PC
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 556 TREJO ST STE B
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City | REXBURG
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State | ID
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Zip | 83440-2626
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Country | US
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Telephone | 208-351-6981
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Fax |
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Provider Business Mailing Address
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Address Line | 556 TREJO STREET SUITE B
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City | REXBURG
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State | ID
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Zip | 83440-2625
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Country | US
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Telephone | 208-351-6981
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RACHELLE JONES
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Credential | FNP-C
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Telephone | 208-881-0902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP-914A
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License Number State | ID
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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 | NP-914A
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP-914A
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | NP-914A
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | NP-914A
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License Number State | ID
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