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NPI Code Detail

MEDICARE: JENNIFER MICHELLE RIES FNP-C

MEDICARE: JENNIFER MICHELLE RIES 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 Practitioner9071440ID
2363LF0000XFamily Nurse Practitioner95011933CA
3363LF0000XFamily Nurse Practitioner4058711KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1F06192019OTHERCAAMERICAN ACADEMY OF NURSE PRACTITIONERS

General Provider Information

NPI Number : 1588226294
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MICHELLE RIES FNP-C
Provider Business Mailing Address
First Line : 1441 NE 10TH AVE
Second Line :
City : PAYETTE
State : ID
Zip : 83661-5420
Country : US
Telephone Number : 208-642-9376
Fax Number : 208-642-9279
Provider Business Practice Location Address
First Line : 300 N PLYMOUTH AVE
Second Line :
City : NEW PLYMOUTH
State : ID
Zip : 83655-5525
Country : US
Telephone Number : 208-278-3335
Fax Number : 208-278-3337
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2019
Last Update Date : 05/29/2026

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Directions to “ JENNIFER MICHELLE RIES FNP-C” Practice Location

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