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

Jay Phan

Individual provider Family Nurse Practitioner · NPI 1669299152

Jay Phan is a Nurse Practitioner in Twin Falls, Idaho. Qualified in 2024, 2 years ago. Practices with Mental Wellness and Relationship Services LLC, an 8-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
2
Licensed in
ID
In the registry since
2024
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

419 Shoup Ave W
Twin Falls, ID 83301-5028
Phone: (209) 996-1700
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 3561779 (ID)

Record details

NPI number1669299152
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 25, 2024
Last updated in NPPESSeptember 25, 2024
Certification dateSeptember 25, 2024
Mailing address604 Lynwood Blvd, Twin Falls, ID 83301-4133

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Mental Wellness And Relationship Services Llc — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Twin Falls