KARISSA DEANN KEENAN (NPI# 1316333107) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316333107 |
| Entity Type | Individual |
| Full Name | KARISSA DEANN KEENAN |
| Other Name | KARISSA HUGHES |
| Credential | M.D. |
| Practice Address |
1072 N Liberty St Ste 100 Boise ID 83704 |
| Mailing Address |
3340 E Goldstone Dr. Meridian ID 83642 |
| Practice Telephone | 2083021200 |
| Practice Fax Number | 2083021255 |
| Mailing Telephone | 2083021200 |
| Mailing Fax Number | 2083021255 |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2019-07-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | M-14675 | ID | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | 10100582-8905 | UT | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | 10100582-1205 | UT | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | UTAH CS SCHEDULE | 10100582-8905 | 01 |
| UT | UTAH LICENSE | 10100582-1205 | 01 |
| Street Address |
1072 N LIBERTY ST STE 100 |
| City | BOISE |
| State | ID |
| Zip Code | 83704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487640561 | James D Redshaw | Psychiatry & Neurology | 1072 N Liberty St, Suite 303, Boise, ID 83704-2800 | 2005-09-23 |
| 1891184115 | Kristin Schmitt Gomes | Advanced Practice Midwife | 1072 N Liberty St, Ste 100, Boise, ID 83704 | 2015-01-12 |
| 1619385119 | Jessica M Herr | Nurse Practitioner | 1072 N Liberty St, Ste 200, Boise, ID 83704 | 2014-07-28 |
| 1093126229 | Colin Alan Lyness | Psychiatry & Neurology | 1072 N Liberty St, Ste 303, Boise, ID 83704 | 2014-05-09 |
| 1215362785 | Heather Ann Wilcke | Nurse Practitioner | 1072 N Liberty St, Suite 303, Boise, ID 83704-2800 | 2013-09-03 |
| 1396188751 | Donraphael Wynn | Ophthalmology | 1072 N Liberty St, Ste 303, Boise, ID 83704 | 2013-04-16 |
| 1518214154 | Heather Marie Johnson | Nurse Practitioner | 1072 N Liberty St, Suite 203, Boise, ID 83704-8708 | 2012-08-14 |
| 1558620781 | Kandiss L Inman | Registered Nurse | 1072 N Liberty St, Suite 100, Boise, ID 83704-8708 | 2012-05-08 |
| 1942568118 | Daniel Prior | Surgery | 1072 N Liberty St, Ste 300, Boise, ID 83704 | 2012-04-25 |
| 1962709550 | Jane Kelsey Spencer | Clinical Nurse Specialist | 1072 N Liberty St, Suite 303, Boise, ID 83704-2800 | 2011-02-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215535893 | Laura Diggs | Counselor | 400 North Benjamin Lane, Suite 200, Boise, ID 83704 | 2020-10-15 |
| 1891304002 | Tree City Family Dental | Dentist | 7301 W. Emerald St Ste. 102, Boise, ID 83704 | 2020-07-24 |
| 1982230710 | Jessica Wynn Councell | Midwife | 1072 N Liberty St Ste 100, Boise, ID 83704 | 2020-03-12 |
| 1699307124 | Isabel Burns Bruce | Registered Nurse | 777 N Raymond Street, Boise, ID 83704 | 2020-02-12 |
| 1558903328 | Daring In Idaho, LLC | Social Worker | 413 N Allumbaugh Street, Suite 102, Boise, ID 83704 | 2019-10-14 |
| 1053960286 | Kyle Hiromi Hatanaka | Acupuncturist | 9450 #120 Fairview Avenue, Boise, ID 83704 | 2019-09-10 |
| 1700447141 | Katie Elizabeth Nichols | Physician Assistant | 1072 N Liberty St Ste 201, Boise, ID 83704 | 2019-06-26 |
| 1588164727 | Cory Michael Sims | Counselor | 6550 W. Emerald St #112, Boise, ID 83704 | 2018-02-14 |
| 1477072270 | Matthew Lee Love | Non-emergency Medical Transport (VAN) | 6933 W. Stratton St, Boise, ID 83704 | 2017-09-12 |
| 1942735949 | Dalana Sue Thompson | Counselor | 9196 Emerald St Suite #130, Boise, ID 83704 | 2017-04-27 |
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| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295001170 | Anne Feighner | Obstetrics & Gynecology | 400 E Idaho St #400, St. Luke's Clinic - The Woman's Clinic, Boise, ID 83712 | 2012-03-26 |
| 1497790075 | Horizon Health Pa | Obstetrics & Gynecology | 311 W Idaho St, Boise, ID 83702-6040 | 2006-06-18 |
| 1588605364 | Patricia Ann Caplinger | Obstetrics & Gynecology | 1055 W. Curtis Rd, Boise, ID 83706-1309 | 2006-06-10 |
| 1740255504 | Shashi Ajmani | Obstetrics & Gynecology | 1072 N Liberty, Suite 100, Boise, ID 83704-8708 | 2006-02-22 |
| 1366435687 | Lauren D. Bales | Obstetrics & Gynecology | 1055 N Curtis Road, Boise, ID 83706 | 2005-08-23 |
| 1932547338 | Paula Jean Durst | Obstetrics & Gynecology | 1055 N Curtis Rd, Boise, ID 83706 | 2013-06-06 |
| 1033554480 | Maryalice Lopez | Obstetrics & Gynecology | 333 N 1st St Ste 240, Boise, ID 83702-6132 | 2013-04-29 |
| 1790028405 | Jessica Marie Riordan | Obstetrics & Gynecology | 1055 N Curtis Rd, Boise, ID 83706-1309 | 2013-04-01 |
| 1154680072 | Eve Preus | Obstetrics & Gynecology | 1072 N Liberty, Ste 100, Boise, ID 83704 | 2012-05-12 |
| 1043509730 | Kylie Marie Cooper | Obstetrics & Gynecology | 333 N 1st St Ste 150, Boise, ID 83702-6135 | 2011-04-04 |
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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.