Provider Demographics
NPI:1295053189
Name:BEVERIDGE-CHOO, TRICIA A (NP)
Entity type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:A
Last Name:BEVERIDGE-CHOO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:BEVERIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-706-8449
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:100 E IDAHO ST
Practice Address - Street 2:STE 300
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6267
Practice Address - Country:US
Practice Address - Phone:208-381-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID21529A363LF0000X
IDNP-974A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily