Provider Demographics
NPI:1437653284
Name:LEROY, MINDY (DNP, PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:LEROY
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 S ORCHARD ST STE A
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-6722
Mailing Address - Country:US
Mailing Address - Phone:541-539-0160
Mailing Address - Fax:208-856-1293
Practice Address - Street 1:4401 N EAGLE RD STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-4818
Practice Address - Country:US
Practice Address - Phone:208-295-4417
Practice Address - Fax:866-455-1021
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200441592RN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily