Individual
MATTHEW AARON DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
1248 E 17TH ST, IDAHO FALLS, ID 83404-6126
(208) 542-1026
Mailing address
1248 E 17TH ST, IDAHO FALLS, ID 83404-6126
(208) 542-1026
(208) 528-2945
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP-78862
ID
Other
Enumeration date
02/09/2024
Last updated
04/15/2026
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