Provider Demographics
NPI:1003312489
Name:WILCOX, ADRIANN J (FNP)
Entity Type:Individual
Prefix:
First Name:ADRIANN
Middle Name:J
Last Name:WILCOX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ADRIANN
Other - Middle Name:
Other - Last Name:JEPPESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:393 E 2ND N
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1605
Mailing Address - Country:US
Mailing Address - Phone:208-356-5401
Mailing Address - Fax:
Practice Address - Street 1:393 E 2ND N
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1605
Practice Address - Country:US
Practice Address - Phone:208-356-5401
Practice Address - Fax:208-356-3111
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID58219207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine