# WESTERN SKIES WELLNESS AND PRIMARY CARE, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568255636
- **Authorized official:** JODI HANEY (CREDENTIALING/CONTRACTING)
- **Authorized official phone:** (541) 410-5394

## Contact information

- **Practice address:** 110 ILLINOIS AVE, COUNCIL, ID 83612
- **Practice address phone:** (208) 849-3725
- **Practice address fax:** (844) 689-3409
- **Mailing address:** PO BOX 158, COUNCIL, ID 83612-0158
- **Mailing address phone:** (208) 849-3725
- **Mailing address fax:** (844) 689-3409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2025
- **Last updated:** 08/07/2026