Individual
JENNIFER LYTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1526 W USTICK RD STE 110, MERIDIAN, ID 83646-7741
(208) 370-5888
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 985-1399
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
67384
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
67384
ID
Other
Enumeration date
02/11/2021
Last updated
03/05/2025
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