Individual
TYSON A HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 239-8033
(208) 785-9450
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 239-8033
(208) 785-9450
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
AP60641080
WA
363LA2200X
Adult Health Nurse Practitioner
Primary
NP-1272A
ID
Other
Enumeration date
03/14/2013
Last updated
05/22/2025
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