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General NPI Number Information
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NPI Number | 1902124142
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Entity Type | Individual
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Provider Name | ELIZABETH PUCKETT THURMOND RN MSN AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 3015 E GOLDSTONE DR STE 230
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City | MERIDIAN
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State | ID
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Zip | 83642-1224
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Country | US
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Telephone | 208-398-4306
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Fax | 208-500-2823
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Provider Business Mailing Address
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Address Line | 9850 ST LUKES DR
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City | NAMPA
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State | ID
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Zip | 83687-7912
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Country | US
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Telephone | 208-505-2108
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 56592
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License Number State | ID
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