Provider Demographics
NPI:1730414947
Name:FARMER, JOSIE F (NP-C)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:F
Last Name:FARMER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4740 N PENNGROVE WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646
Mailing Address - Country:US
Mailing Address - Phone:208-938-3663
Mailing Address - Fax:208-938-3664
Practice Address - Street 1:4740 N PENNGROVE WAY
Practice Address - Street 2:STE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:208-938-3663
Practice Address - Fax:208-938-3664
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 936A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1349042OtherMEDICARE PTAN
ID808552900Medicaid