Provider Demographics
NPI:1952617896
Name:HARRINGTON, CLAYLEEN JO (FNP)
Entity Type:Individual
Prefix:
First Name:CLAYLEEN
Middle Name:JO
Last Name:HARRINGTON
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 1:943 N LINDER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-3395
Mailing Address - Country:US
Mailing Address - Phone:208-565-0978
Mailing Address - Fax:208-902-3834
Practice Address - Street 1:943 N LINDER RD STE 103
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-3395
Practice Address - Country:US
Practice Address - Phone:208-565-0978
Practice Address - Fax:208-902-3834
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID59691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDIDTPID013642Medicaid