Provider Demographics
NPI:1942485180
Name:DELACY, KARA (FNP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:DELACY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N STILSON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5145
Mailing Address - Country:US
Mailing Address - Phone:208-332-4540
Mailing Address - Fax:
Practice Address - Street 1:801 N STILSON RD STE 300
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-5145
Practice Address - Country:US
Practice Address - Phone:208-332-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-32262163W00000X
IDNP-887A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1341120Medicare PIN