MEDICARE: MRS. KATIE CAMPOS 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
1	363LF0000X	Family Nurse Practitioner	68134	ID

General Provider Information

NPI Number	:	1841795804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATIE CAMPOS FNP-C

Provider Business Mailing Address
First Line	:	619 S WASHINGTON ST STE 203
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-3063
Country	:	US
Telephone Number	:	208-892-1346
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 S WASHINGTON ST STE 203
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-3063
Country	:	US
Telephone Number	:	208-892-1346
Fax Number	:

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

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	11/11/2025

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