MEDICARE: JILLIAN ALEXA RIPPEY ARNP

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	71512	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP60750903	OTHER	WA	STATE LICENSE
2	71512	OTHER	ID	LICENSE

General Provider Information

NPI Number	:	1225566292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN ALEXA RIPPEY ARNP

Provider Business Mailing Address
First Line	:	600 E STATE ST STE 200
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-6082
Country	:	US
Telephone Number	:	208-856-6401
Fax Number	:	208-217-9213

Provider Business Practice Location Address
First Line	:	600 E STATE ST STE 200
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-6082
Country	:	US
Telephone Number	:	208-865-6401
Fax Number	:	208-217-9213

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

Provider Enumeration Date	:	06/02/2017
Last Update Date	:	12/29/2025

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