Provider Demographics
NPI:1447091087
Name:CHERMAK, ASHLEY ARCY RACHAEL (PMHNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ARCY RACHAEL
Last Name:CHERMAK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 SHEFFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7998
Mailing Address - Country:US
Mailing Address - Phone:208-243-5834
Mailing Address - Fax:208-656-9466
Practice Address - Street 1:685 1ST ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4003
Practice Address - Country:US
Practice Address - Phone:208-932-4493
Practice Address - Fax:208-656-9466
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2024041130363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health