Individual
LEAH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-7350
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN00155803
WA
363LA2100X
Acute Care Nurse Practitioner
AP61051873
WA
363LG0600X
Gerontology Nurse Practitioner
Primary
72172
ID
363LG0600X
Gerontology Nurse Practitioner
AP61051873
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AP61051873
—
WA
Enumeration date
11/09/2017
Last updated
10/13/2023
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