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General NPI Number Information
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NPI Number | 1881301075
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Entity Type | Individual
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Provider Name | JON PATXI CRISWELL FNP-C
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Gender | Male
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Dates
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Enumeration Date | 10/28/2022
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 63 W WILLOWBROOK DR
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City | MERIDIAN
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State | ID
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Zip | 83646-1656
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Country | US
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Telephone | 208-888-7877
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Fax | 208-593-3671
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Provider Business Mailing Address
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Address Line | 63 W WILLOWBROOK DR
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City | MERIDIAN
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State | ID
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Zip | 83646-1656
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Country | US
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Telephone | 88-887-8772
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Fax | 208-593-3671
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 61604
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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 | 61604
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 899421
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License Number State | ID
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