Individual
TYSON SMITHERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
3200 CHANNING WAY STE 206, IDAHO FALLS, ID 83404-7546
(208) 529-2230
(208) 561-8061
Mailing address
3200 CHANNING WAY STE 206, IDAHO FALLS, ID 83404-7546
(208) 529-2230
(208) 561-8061
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
10808238-4405
UT
363LF0000X
Family Nurse Practitioner
Primary
2361278
ID
Other
Enumeration date
12/26/2021
Last updated
01/15/2025
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