Individual
CODY JUSTIN DAVIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
520 S EAGLE RD STE 1234, MERIDIAN, ID 83642-6355
(208) 429-0300
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
201393795NP-PP
OR
363LF0000X
Family Nurse Practitioner
Primary
NP-1586A
ID
Other
Enumeration date
04/23/2014
Last updated
02/27/2023
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