MR. WILEY DREW PETERSEN (NPI# 1568920080) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568920080 |
| Entity Type | Individual |
| Full Name | MR. WILEY DREW PETERSEN |
| Credential | PA-C |
| Practice Address |
717 Mission Rd Fort Hall ID 83203 |
| Mailing Address |
Po Box 306 Fort Hall ID 83203-0306 |
| Practice Telephone | 2082385435 |
| Practice Fax Number | 2082385440 |
| Mailing Telephone | 2082385435 |
| Mailing Fax Number | 2082385440 |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2019-03-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | PA-1714 | ID | Allopathic & Osteopathic Physicians |
| Street Address |
717 MISSION RD |
| City | FORT HALL |
| State | ID |
| Zip Code | 83203 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508920869 | Richard Lee Mittelstedt | Registered Nurse | 717 Mission Rd, Fort Hall, ID 83203-0717 | 2006-12-21 |
| 1043541543 | Drew Harold Burrell | Behavioral Analyst | 717 Mission Rd, 306, Fort Hall, ID 83203-0306 | 2010-01-22 |
| 1225369820 | Kristina M Kniffen | Licensed Practical Nurse | 717 Mission Rd, Fort Hall, ID 83203-0306 | 2010-01-21 |
| 1700115995 | Stephanie Moss | Registered Nurse | 717 Mission Rd, Fort Hall, ID 83203-0717 | 2009-12-17 |
| 1285876938 | Garth S Brown | Registered Nurse | 717 Mission Rd, Fort Hall, ID 83203-0306 | 2009-03-26 |
| 1689816563 | Brandy Pugmire | Licensed Practical Nurse | 717 Mission Rd, Fort Hall, ID 83203-0717 | 2009-03-24 |
| 1457598575 | Joanne Fletcher | Registered Nurse | 717 Mission Rd, Fort Hall, ID 83203-0306 | 2009-01-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154765238 | Chief Tahgee Elementary Academy, Inc. | Local Education Agency (LEA) | 38 South Hiline Road, Fort Hall, ID 83203 | 2013-04-19 |
| 1730304171 | Shari L. Newsome | Social Worker | Mission Road Building 248, Fort Hall Indian Agency, Fort Hall, ID 83203 | 2007-04-13 |
| 1780808899 | Scotti L Brownley | Counselor | Mission Road Bldg 248, Fort Hall Indian Agency, Fort Hall, ID 83203 | 2007-04-12 |
| 1932323045 | Kristy Lee Broncho | Social Worker | Mission Road Blding 248, Fort Hall Indian Agency, Fort Hall, ID 83203 | 2007-04-12 |
| 1972632834 | Not-tsoo Gah-nee Indian Health Center Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Route 6 Mission Rd, Fort Hall, ID 83203 | 2007-03-05 |
| 1346259355 | Holly J Mcgrath | Pharmacist | Mission Rd, Box 717, Fort Hall, ID 83203 | 2006-08-07 |
| 1073518163 | Thomas John Troshynski | Pharmacist | 1 Mission Road, Fort Hall, ID 83203 | 2005-06-16 |
| 1497262216 | Cameron Jo Marshall | Pharmacist | Mission Road, Fort Hall, ID 83203 | 2018-01-02 |
| 1225570716 | Shoshone-bannock Community Health Center | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Navajo Drive Bldg 70, Fort Hall, ID 83203 | 2016-11-15 |
| 1366847428 | Daniel Jerome Hall | Social Worker | 717 Mission Road, Fort Hall, ID 83203 | 2014-10-30 |
| Find all providers in zip 83203 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962416701 | James Fred Vook | Family Medicine | Mission Road, Fort Hall, ID 83203-0717 | 2006-07-28 |
| 1881608644 | Douglas Lyons | Family Medicine | Mission Road, Fort Hall, ID 83203-0717 | 2006-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699375659 | Jonathan Barrus Do PC | Family Medicine | 2020 S Johns Avenue, Emmett, ID 83617 | 2020-10-29 |
| 1750998126 | Story Family Medicine | Family Medicine | 1150 Alturas Dr Ste 101, Moscow, ID 83843-3263 | 2020-09-29 |
| 1780298430 | Alliance Medical Group, LLC | Family Medicine | Kuna Primary Health Medical Group, 1474 N. Meridian Road, Kuna, ID 83634 | 2020-09-01 |
| 1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
| 1447880570 | Bore LLC | Family Medicine | 1498 Midway Ave Ste 2, Ammon, ID 83406-4587 | 2020-01-16 |
| 1669038220 | Savannah M Klinginsmith | Family Medicine | 17866 Polara Way, Nampa, ID 83687-9159 | 2019-05-18 |
| 1487218814 | Logan Perkins | Family Medicine | 132 5th Ave W Ste 2, Jerome, ID 83338-1825 | 2019-05-01 |
| 1588227656 | Traci H Permenter | Family Medicine | 943 N Linder Rd Ste 103, Kuna, ID 83634-3395 | 2019-04-15 |
| 1790244424 | Destin Thayne Bep Inc | Family Medicine | 859 S Yellowstone Hwy Ste 304, Rexburg, ID 83440-5294 | 2019-03-12 |
| 1447718853 | Root Cause Integrative Medicine LLC | Family Medicine | 1547 S Midway Ave, Suite B, Ammon, ID 83406 | 2019-03-05 |
| Find all providers with the same taxonomy | ||||
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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.