Provider Demographics
NPI:1376597559
Name:STROUD, JAMI LYNN (MS, RN, FNPC)
Entity Type:Individual
Prefix:MS
First Name:JAMI
Middle Name:LYNN
Last Name:STROUD
Suffix:
Gender:F
Credentials:MS, RN, FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3392
Mailing Address - Country:US
Mailing Address - Phone:208-737-9999
Mailing Address - Fax:208-735-2426
Practice Address - Street 1:1373 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3392
Practice Address - Country:US
Practice Address - Phone:208-737-9999
Practice Address - Fax:208-735-2426
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-336A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805037600Medicaid
ID805037600Medicaid
ID1342612Medicare PIN