Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Benjamin Walker Pennock

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1720874555

Benjamin Walker Pennock is a Student in an Organized Health Care Education/Training Program in Boise, Idaho. Licensed in Idaho. Registered with an NPI since 2025.

Licensed in
ID
In the registry since
2025
Specialties on file
2

Practice location Address checks out

500 W Fort St
Boise, ID 83702-4501
Phone: (208) 422-1000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X · Licence 3071063 (ID)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1720874555
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 17, 2025
Last updated in NPPESMay 15, 2025
Certification dateMay 15, 2025
Mailing address500 W Fort St, Boise, ID 83702-4501

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