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NPI Code Detail

MEDICARE: SHAYLYNN SHERRICK SMITH FNP-C

MEDICARE: SHAYLYNN SHERRICK SMITH FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner79295ID

General Provider Information

NPI Number : 1013764224
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAYLYNN SHERRICK SMITH FNP-C
Provider Business Mailing Address
First Line : 1624 GINGKO ST
Second Line :
City : RUPERT
State : ID
Zip : 83350-1131
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2303 PARK AVE
Second Line :
City : BURLEY
State : ID
Zip : 83318-2106
Country : US
Telephone Number : 208-677-3073
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2024
Last Update Date : 05/06/2024

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