Blake Odoherty, Beverley Ann

Blake Odoherty, Beverley Ann is an sole proprietor health care provider with primary practice located at 777 Hospital Way , Pocatello ID 83201-5175. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Blake Odoherty, Beverley Ann can be contacted via phone (208) 239-1000.

Contact Information

Primary practice address
777 Hospital Way Pocatello ID 83201-5175
Phone: (208) 239-1000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN172038 Colorado
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X NP925A Idaho

Profile Details

NPI number 1821166539
LBN Legal business name Blake Odoherty, Beverley Ann
Credentials Certified Family Nurse Practitioner (CFNP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 1st, 2006
Last updated Jul 20th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821166539 NPPES
Colorado MEDICAID 16301862

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