1447091087 NPI number — ASHLEY ARCY RACHAEL CHERMAK PMHNP

Table of content: ASHLEY ARCY RACHAEL CHERMAK PMHNP (NPI 1447091087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447091087 NPI number — ASHLEY ARCY RACHAEL CHERMAK PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHERMAK
Provider First Name:
ASHLEY
Provider Middle Name:
ARCY RACHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447091087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 SHEFFIELD CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IDAHO FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83404-7998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-243-5834
Provider Business Mailing Address Fax Number:
208-656-9466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
685 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDAHO FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83401-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-932-4493
Provider Business Practice Location Address Fax Number:
208-656-9466
Provider Enumeration Date:
06/06/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  2024041130 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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