MEDICARE: MINDFUL HEALING PSYCHIATRY OF IDAHO

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	:	1740122647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL HEALING PSYCHIATRY OF IDAHO

Provider Business Mailing Address
First Line	:	8377 E COPENHAVER ST
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-4824
Country	:	US
Telephone Number	:	360-485-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 E GOLDSTONE DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-1549
Country	:	US
Telephone Number	:	208-614-4611
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH ANN PURCELL
Credential	:	MSN, PMHNP
Telephone Number	:	208-614-4611

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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