MEDICARE: JAN REHDER KING 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
1	363LF0000X	Family Nurse Practitioner	NP-1404A	ID

General Provider Information

NPI Number	:	1083038335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN REHDER KING FNP-C

Provider Business Mailing Address
First Line	:	5333 N BROOKMEADOW WAY
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-1480
Country	:	US
Telephone Number	:	208-866-5333
Fax Number	:	769-206-4683

Provider Business Practice Location Address
First Line	:	2867 E COPPER POINT DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-1716
Country	:	US
Telephone Number	:	208-401-9100
Fax Number	:	208-401-9150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2014
Last Update Date	:	12/18/2023

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