TRUDY BEARDEN (NPI# 1639151848) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639151848 |
| Entity Type | Individual |
| Full Name | TRUDY BEARDEN |
| Credential | PA-C |
| Practice Address |
465 Memorial Dr Pocatello ID 83209-0001 |
| Mailing Address |
465 Memorial Dr Pocatello ID 83201-4008 |
| Practice Telephone | 2082824700 |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2009-08-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA-543 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | PA LICENSE NUMBER | PA-543 | 01 |
| Street Address |
465 MEMORIAL DR |
| City | POCATELLO |
| State | ID |
| Zip Code | 83209-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578555603 | Nicole Murdock | Pharmacist | 465 Memorial Dr, Pocatello, ID 83201-4008 | 2005-08-16 |
| 1538785191 | Kailey Jo Murphy | Pharmacist | 465 Memorial Dr, Pocatello, ID 83201-4008 | 2020-06-19 |
| 1568087435 | Sye Speth | Family Medicine | 465 Memorial Dr, Pocatello, ID 83201-4008 | 2020-06-16 |
| 1376168013 | Martin Steele | Family Medicine | 465 Memorial Dr, Pocatello, ID 83201-4008 | 2020-06-09 |
| 1356965396 | Jokke Kokkonen | Family Medicine | 465 Memorial Dr, Pocatello, ID 83201-4008 | 2020-06-05 |
| 1649894692 | Richard John | Family Medicine | 465 Memorial Dr, Pocatello, ID 83201-4008 | 2020-06-05 |
| 1972127942 | Tyshae Jaggi | Family Medicine | 465 Memorial Dr, Pocatello, ID 83201-4008 | 2020-06-04 |
| 1003430174 | Emily Davis | Family Medicine | 465 Memorial Dr, Pocatello, ID 83201-4008 | 2020-06-03 |
| 1134743628 | Brandon Dean Comish | Family Medicine | 465 Memorial Dr, Pocatello, ID 83201-4008 | 2020-06-01 |
| 1598318792 | Brandon Griffin | Dentist | 465 Memorial Dr, Pocatello, ID 83201-4008 | 2019-07-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093097081 | Eydie Kendall | Physical Therapist | 1400 Terry Drive, Pocatello, ID 83209 | 2011-09-15 |
| 1548548589 | Corrie Elizabeth Holmes | Audiologist | 650 Memorial Drive Building 68, Pocatello, ID 83209 | 2011-07-25 |
| 1730351081 | Idaho State University | Pharmacy | 990 South 8th, Pocatello, ID 83209 | 2008-03-27 |
| 1922204551 | Melody Ann Weaver | Nurse Practitioner | 921 S 8th Ave Stop 8101, Pocatello, ID 83209 | 2007-06-21 |
| 1710482500 | Ashley Letson | Specialist/Technologist | 921 S 8th Ave, Mcintosh Manor D9, Pocatello, ID 83209 | 2018-03-26 |
| 1407261407 | Stephen B Grandy | Dentist | 465 Memorial Drive, Pocatello, ID 83209-0000 | 2014-06-27 |
| 1811595929 | Idaho State University | Counselor | 1400 E Terry Dr Bldg 63, Pocatello, ID 83209-0001 | 2020-10-12 |
| 1174149389 | Santiago A Segura Barron | Specialist/Technologist | Holt Arena 550 Memorial Drive Building 50, Pocatello, ID 83209-0001 | 2020-06-23 |
| 1639658248 | Luis Rodriguez | Psychologist | 1400 Eas Terry Dr Bldg 63 Garrison Hall 5th Floor, Pocatello, ID 83209-0001 | 2018-08-14 |
| 1205384484 | Max Esposito | Physical Medicine & Rehabilitation | 1400 E Terry Dr, Pocatello, ID 83209-0001 | 2016-09-15 |
| Find all providers in zip 83209 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720379597 | Lance W Mckay | Physician Assistant | 1151 Hospital Way, Bld D, Pocatello, ID 83201-5091 | 2011-04-27 |
| 1467602920 | Stephanie Theresa Hanson | Physician Assistant | 11460 N Philbin Rd, Pocatello, ID 83202-5306 | 2008-09-22 |
| 1780867457 | Southeast Idaho Gastroenterology, Pllc | Physician Assistant | 1151 Hospital Way Ste A, Pocatello, ID 83201-5091 | 2007-12-17 |
| 1174711758 | Rsm Pa Pllc | Physician Assistant | 1595 Bannock Hwy, Pocatello, ID 83204 | 2007-10-09 |
| 1760597462 | Karen Dickerson | Physician Assistant | 1352 E Center St, Pocatello, ID 83201-4734 | 2006-08-20 |
| 1265441547 | Nicole Manning | Physician Assistant | 475 Yellowstone Ave, Ste E, Pocatello, ID 83201-4528 | 2006-08-05 |
| 1124040506 | Michael John Doyle | Physician Assistant | 921 S 8th Ave Stop 8311, Pocatello, ID 83209-0002 | 2006-07-24 |
| 1417909862 | Cynthia Ann Bunde | Physician Assistant | 429 Washington Ave, Pocatello, ID 83201-4520 | 2006-05-16 |
| 1750342952 | Kebai Dawn Bills | Physician Assistant | 1777 E. Clark Suite # 210, Pocatello, ID 83201 | 2006-03-29 |
| 1073513065 | Helena M. B. Rizor | Physician Assistant | 1448 E Center St, Pocatello, ID 83201-4105 | 2005-07-30 |
| Find all providers in POCATELLO | ||||
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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.