Provider Demographics
NPI:1083038335
Name:KING, JAN REHDER (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:REHDER
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:REHDER-JUNGERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5333 N BROOKMEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1480
Mailing Address - Country:US
Mailing Address - Phone:208-866-5333
Mailing Address - Fax:769-206-4683
Practice Address - Street 1:2867 E COPPER POINT DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1716
Practice Address - Country:US
Practice Address - Phone:208-401-9100
Practice Address - Fax:208-401-9150
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1404A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily