MEDICARE: MICHELLE HARCOURT FNP

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	61016	ID
2	163W00000X	Registered Nurse	42111	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61016	OTHER	ID	FAMILY NURSE PRACTITIONER
2	42111	OTHER	ID	REGISTERED NURSE

General Provider Information

NPI Number	:	1780150979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE HARCOURT FNP

Provider Business Mailing Address
First Line	:	2114 VILLAGE PARK AVE STE 200
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4172
Country	:	US
Telephone Number	:	208-441-0767
Fax Number	:	208-441-0367

Provider Business Practice Location Address
First Line	:	2114 VILLAGE PARK AVE STE 200
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4172
Country	:	US
Telephone Number	:	208-441-0767
Fax Number	:	208-441-0367

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

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	03/19/2025

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Directions to “ MICHELLE HARCOURT FNP” Practice Location

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