Individual
CHERISH L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
300 E JEFFERSON ST, SUITE 300, BOISE, ID 83712-6246
(208) 381-4100
(208) 381-4101
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
(208) 381-4101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA385
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149864
REGENCE BLUE SHIELD
ID
01
—
40659
BLUE CROSS
ID
05
—
806367900
—
ID
01
—
PAVE5
TRUE BLUE
ID
Enumeration date
01/25/2006
Last updated
11/06/2012
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