Tennessee PHS PC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

TENNESSEE PHS PC

Practice address

950 W. Bannock Street
Suite 1100
Boise, ID 83702-6140

Phone

(877) 260-4747

Fax

(901) 261-4867

NPI assigned

Feb 29, 2012

Organization subpart

Yes

Parent organization

PROVIDER HEALTH SERVICES LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole Howard

Title

Cfo

Phone

(337) 991-9276

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404259200000",
    "number": "1063786648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 DULLES DRIVE",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70506",
            "telephone_number": "337-991-9276",
            "fax_number": "337-991-9288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 W. BANNOCK STREET",
            "address_2": "SUITE 1100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026140",
            "telephone_number": "877-260-4747",
            "fax_number": "901-261-4867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE PHS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDER HEALTH SERVICES LLC",
        "enumeration_date": "2012-02-29",
        "last_updated": "2014-07-02",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-991-9276"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063786648",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Faith Ten Doeschate, LMSW
• Monica Tenaya, LMT
• Clifford L Tenley, M.D.
• Brenda Tennant, LCSW
• Chelsea Dylan Tennent, PA-C
• Oscar Terrazas Jr., D.C.
• Ariel Terry
• Linda S Terry, LPC, LAMFT
• Mynley Terry
• Beruk Welderufael Tesfamariam Sr.

• Nurse Practitioner in Boise, ID
• Providers in Boise, ID by specialty
• Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.