Provider Demographics
NPI:1639966005
Name:MATHEWS, SAPHRONA KIM
Entity type:Individual
Prefix:
First Name:SAPHRONA
Middle Name:KIM
Last Name:MATHEWS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2984 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0315
Mailing Address - Country:US
Mailing Address - Phone:208-999-1245
Mailing Address - Fax:
Practice Address - Street 1:2984 N 26TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-0315
Practice Address - Country:US
Practice Address - Phone:208-999-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11833104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness