Individual ProviderMisty NeisenPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address100 E Idaho St, Boise, ID 83712-6267(208) 381-2711(208) 381-2222PECOS EnrollmentBased on the most recent information from CMS, provider Misty Neisen is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1023409265Provider TypeIndividualFull NameNeisen, MistyGenderFemaleSole ProprietorNoEnumeration Date2/10/2015Last Updated3/28/2022Contact InformationPractice LocationPractice Address100 E Idaho St, Boise, ID 83712-6267Phone(208) 381-2711Fax(208) 381-4025Mailing LocationMailing Address190 E Bannock St, Boise, ID 83712-6241Phone(208) 381-2222FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA1189Idaho