Individual
CLINT EMMETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
875 PERIMETER DR # MS 3140, MOSCOW, ID 83844-2006
(208) 885-6716
(208) 885-4354
Mailing address
600 E E ST, MOSCOW, ID 83843-2713
(603) 915-6135
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
07060823
NH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
61523
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07060823
NH APRN LICENSE
NH
01
—
61523
ID APRN LICENSE
ID
Enumeration date
10/06/2014
Last updated
03/08/2021
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