Provider Demographics
NPI:1649824277
Name:SMITH, BRYANA MICHEL (FNP-BC)
Entity type:Individual
Prefix:
First Name:BRYANA
Middle Name:MICHEL
Last Name:SMITH
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BRYANA
Other - Middle Name:MICHEL
Other - Last Name:HINCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-955-6500
Mailing Address - Fax:208-955-6501
Practice Address - Street 1:3280 E LANARK DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5982
Practice Address - Country:US
Practice Address - Phone:208-895-8670
Practice Address - Fax:208-955-0494
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID62050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner