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General NPI Number Information
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NPI Number | 1902791932
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Entity Type | Organization
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Legal Business Name | BRIDGES OF HOPE PSYCHIATRY
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 370 N MERIDIAN ST STE A
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City | BLACKFOOT
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State | ID
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Zip | 83221-1625
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Country | US
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Telephone | 208-851-4315
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Fax |
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Provider Business Mailing Address
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Address Line | 370 N MERIDIAN ST STE A
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City | BLACKFOOT
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State | ID
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Zip | 83221-1625
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Country | US
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Telephone | 208-681-9453
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | BROOKE NICHOLE BROWN
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Credential | PMHNP-BC
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Telephone | 208-681-9453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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