Organization
ADDI
Active
Parent organization
MERIDIAN ADVANCED PSYCHIATRY , LLC
Other names
ADD Clinic of Idaho, ADDI, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MERIDIAN ADVANCED PSYCHIATRY , LLC
Authorized official
KYLE RONNAU NP, PMHNP (CEO/MEDICAL DIRECTOR)
(208) 515-2273
Entity
Organization
Contact information
Practice address
1526 W USTICK RD STE 110, MERIDIAN, ID 83646-7741
(208) 370-5888
Mailing address
1672 S WOODSAGE AVE, MERIDIAN, ID 83642-8329
(208) 515-2273
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/01/2024
Last updated
10/14/2024
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