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NPI Code Detail

MEDICARE: DR. RYAN NATHANIEL BOPP NP-C

MEDICARE: DR. RYAN NATHANIEL BOPP NP-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
1363LA2200XAdult Health Nurse Practitioner7871063ID
2363LF0000XFamily Nurse Practitioner7871063ID

General Provider Information

NPI Number : 1588522189
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYAN NATHANIEL BOPP NP-C
Provider Business Mailing Address
First Line : 9383 W AUTUMN LN
Second Line :
City : POCATELLO
State : ID
Zip : 83204-7227
Country : US
Telephone Number : 208-232-9403
Fax Number :
Provider Business Practice Location Address
First Line : 5633 N LIDGERWOOD ST
Second Line :
City : SPOKANE
State : WA
Zip : 99208-1224
Country : US
Telephone Number : 509-482-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2026
Last Update Date : 01/12/2026

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