Provider Demographics
NPI:1043621576
Name:BOLE, BECKY (ANP, PMHNP)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:BOLE
Suffix:
Gender:F
Credentials:ANP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 17TH AVE S STE 5
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4781
Mailing Address - Country:US
Mailing Address - Phone:208-918-2675
Mailing Address - Fax:208-918-8627
Practice Address - Street 1:824 17TH AVE S STE 5
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4781
Practice Address - Country:US
Practice Address - Phone:208-918-2675
Practice Address - Fax:208-918-8627
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID62791363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health