POCATELLO WELLNESS CLINIC LLC (NPI# 1437615952) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437615952 |
| Entity Type | Organization |
| Organization Name | POCATELLO WELLNESS CLINIC LLC |
| Practice Address |
1155 Yellowstone Ave Ste D Pocatello ID 83201-4369 |
| Mailing Address |
1511 Golden Gate St Pocatello ID 83201-2258 |
| Practice Telephone | 2086379610 |
| Practice Fax Number | 2082386162 |
| Mailing Telephone | 2082210538 |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2020-03-17 |
| Authorized Official Name | DUSTIN RENO (OWNER) |
| Authorized Official Telephone | 2082210538 |
| Authorized Official Credential | NP-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1155 YELLOWSTONE AVE STE D |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-4369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568906865 | Dustin Reno | Nurse Practitioner | 1155 Yellowstone Ave Ste D, Pocatello, ID 83201-4369 | 2016-12-06 |
| 1700491933 | Margaret Elizabeth Jablonski | Nurse Practitioner | 1155 Yellowstone Ave Ste D, Pocatello, ID 83201-4369 | 2020-09-14 |
| 1184257818 | Jessicka Lynn Price | Nurse Practitioner | 1155 Yellowstone Ave Ste D, Pocatello, ID 83201-4369 | 2020-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679183388 | Health Innovations, LLC | Nurse Practitioner | 240 N 18th Ave, Pocatello, ID 83201-3324 | 2020-08-06 |
| 1285295634 | Rebekah Lucero | Nurse Practitioner | 2185 Steven St, Pocatello, ID 83201-1928 | 2019-06-26 |
| 1285199869 | Jason Knighton | Nurse Practitioner | 5800 S 5th Ave, Pocatello, ID 83204-2205 | 2019-02-07 |
| 1356812945 | Dellisa Dawn Eddington | Nurse Practitioner | 6000 S 5th Ave, Pocatello, ID 83204-5075 | 2018-12-08 |
| 1457839730 | In Balance: Integrative Primary Healthcare Pllc | Nurse Practitioner | 1017 E Young St, Pocatello, ID 83201-5237 | 2018-07-30 |
| 1851885420 | Jordan Clay Chapman | Nurse Practitioner | 777 Hospital Way Ofc Bldg, Pocatello, ID 83201-2797 | 2018-06-18 |
| 1356846398 | Paul Haislip | Nurse Practitioner | 340 N 14th Ave, Pocatello, ID 83201-4118 | 2018-03-29 |
| 1568906865 | Dustin Reno | Nurse Practitioner | 1155 Yellowstone Ave Ste D, Pocatello, ID 83201-4369 | 2016-12-06 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1376992503 | Andrea Walsh | Nurse Practitioner | 1133 Call Creek Dr, Ste A, Pocatello, ID 83202 | 2016-06-08 |
| Find all providers in POCATELLO | ||||
Please comment or provide details below to improve the information on POCATELLO WELLNESS CLINIC LLC.
| 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.