# PRISM FAMILY MEDICINE LLC

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

## Provider details

- **NPI number:** 1942028592
- **Authorized official:** DR. JESSICA J ROLYNN MD (OWNER)
- **Authorized official phone:** (208) 806-4581

## Contact information

- **Practice address:** 1950 E CLARK ST STE 100, POCATELLO, ID 83201-3315
- **Practice address phone:** (208) 806-4581
- **Practice address fax:** (208) 837-3010
- **Mailing address:** 1950 E CLARK ST STE 100, POCATELLO, ID 83201-3315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/02/2024
- **Last updated:** 10/03/2024