Provider Demographics
NPI:1265891261
Name:SMITH, DAELYNN JO (FNP)
Entity type:Individual
Prefix:
First Name:DAELYNN
Middle Name:JO
Last Name:SMITH
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 1:1404 POMERELLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2012
Mailing Address - Country:US
Mailing Address - Phone:208-878-9432
Mailing Address - Fax:208-878-4576
Practice Address - Street 1:1404 POMERELLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2012
Practice Address - Country:US
Practice Address - Phone:208-878-9432
Practice Address - Fax:208-878-4576
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1705A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily