TENNESSEE PHS PC (NPI# 1063786648) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063786648 |
| Entity Type | Organization |
| Organization Name | TENNESSEE PHS PC |
| Practice Address |
950 W. Bannock Street Suite 1100 Boise ID 83702-6140 |
| Mailing Address |
1509 Dulles Drive Lafayette LA 70506 |
| Practice Telephone | 8772604747 |
| Practice Fax Number | 9012614867 |
| Mailing Telephone | 3379919276 |
| Mailing Fax Number | 3379919288 |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2014-07-02 |
| Authorized Official Name | NICOLE HOWARD (CFO) |
| Authorized Official Telephone | 3379919276 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDER HEALTH SERVICES LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 1063786648 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184854473 | Tennessee Phs PC | Family Medicine | 9155 Crestwyn Hills Dr, Memphis, TN 38125-8501 | 2009-07-21 |
| Street Address |
950 W. BANNOCK STREET SUITE 1100 |
| City | BOISE |
| State | ID |
| Zip Code | 83702-6140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
| 1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
| 1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
| 1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
| 1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
| 1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
| 1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
| 1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
| Find all providers in zip 83702 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588288336 | Katina Ross | Nurse Practitioner | 11695 W Baserri Dr, Boise, ID 83709-1307 | 2020-06-07 |
| 1932741212 | Kylie B Di Lulo | Nurse Practitioner | 1309 E Fall Ct, Boise, ID 83706-5076 | 2019-10-08 |
| 1033638150 | Michael P Lorentzen | Nurse Practitioner | 190 E Bannock St Fl 9, Boise, ID 83712-6241 | 2017-09-11 |
| 1194093344 | Ella Mae Gordon | Nurse Practitioner | 450 West State Street, 4th Floor, Boise, ID 83720-0036 | 2011-12-02 |
| 1174839666 | Meghann R Bostrom | Nurse Practitioner | 13099 W Paint Dr, Boise, ID 83713-1927 | 2010-08-23 |
| 1255653796 | Natalia Khochay | Nurse Practitioner | 1075 N. Curtis Rd., Suite 200, Boise, ID 83706-1300 | 2010-02-25 |
| 1164670378 | Janet Mcreynolds Pelton | Nurse Practitioner | 2074 Roanoke Dr, Boise, ID 83712-7529 | 2008-08-29 |
| 1619155249 | Loreen Anne Nugent | Nurse Practitioner | 3611 Tamarack Dr, Boise, ID 83703-4551 | 2008-02-06 |
| 1891904132 | Mario P Martinez | Nurse Practitioner | 1075 S Curtis Rd, Suite 200, Boise, ID 83706-1350 | 2007-05-22 |
| 1043334477 | Sally Suter | Nurse Practitioner | 704 S Latah, The Friendship Clinic, Boise, ID 83706 | 2007-03-19 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.