Individual
ABBY JAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC, RD, CDCES
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-4100
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
002152
IA
133V00000X
Registered Dietitian
D-795
ID
363LF0000X
Family Nurse Practitioner
Primary
3771381
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134168263
HOSPITAL NPI#
IA
01
—
1790751055
HOSPITAL NPI#
ID
Enumeration date
09/03/2013
Last updated
05/24/2026
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