MEDICARE: STOVALL PSYCHIATRIC SERVICES, PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1669305314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STOVALL PSYCHIATRIC SERVICES, PLLC

Provider Business Mailing Address
First Line	:	6954 N COURCELLES PKWY
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-8334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6954 N COURCELLES PKWY
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-8334
Country	:	US
Telephone Number	:	986-270-4780
Fax Number	:

Authorized Official
Title or Position	:	ARNP
Name	:	JAYMIE STOVALL
Credential	:	PMHNP-BC
Telephone Number	:	986-270-4780

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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