Provider Demographics
NPI:1376069724
Name:WILLIAMS, JOSHUA TREVOR (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TREVOR
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N 3707 E
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5325
Mailing Address - Country:US
Mailing Address - Phone:208-403-8683
Mailing Address - Fax:
Practice Address - Street 1:3425 POTOMAC WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4970
Practice Address - Country:US
Practice Address - Phone:208-528-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID56662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily