Individual
ADAM JOSEPH THETFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, PMHNP
Contact information
Practice address
315 LUV PL, AMMON, ID 83406-4511
(208) 821-4357
Mailing address
315 LUV PL, AMMON, ID 83406-4511
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5981802
ID
Other
Enumeration date
05/01/2026
Last updated
05/01/2026
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