JENNIFER L WISTISEN (NPI# 1851870091) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851870091 |
| Entity Type | Individual |
| Full Name | JENNIFER L WISTISEN |
| Credential | PA |
| Practice Address |
98 Poplar St Blackfoot ID 83221-1799 |
| Mailing Address |
382 W 160 N Apt 3 Blackfoot ID 83221-5674 |
| Practice Telephone | 2087854100 |
| Mailing Telephone | 2086045442 |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2018-08-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
98 POPLAR ST |
| City | BLACKFOOT |
| State | ID |
| Zip Code | 83221-1799 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609871474 | Wade H Flowers Jr. | Pharmacist | 98 Poplar St, Blackfoot, ID 83221-1758 | 2005-06-16 |
| 1629685177 | Lucus Craig Webb Christoffersen | Registered Nurse | 98 Poplar St, Blackfoot, ID 83221-1799 | 2020-09-29 |
| 1770111924 | Kywnynn Madsen | Dietitian, Registered | 98 Poplar St, Blackfoot, ID 83221-1758 | 2020-03-31 |
| 1235795915 | Megan Lewis | Advanced Practice Midwife | 98 Poplar St, Blackfoot, ID 83221-1758 | 2019-05-17 |
| 1083177935 | Jason Lee Harmon | Student in an Organized Health Care Education/Training Program | 98 Poplar St, Blackfoot, ID 83221-1758 | 2019-04-08 |
| 1114405396 | Ryan Blair Killpack | Physician Assistant | 98 Poplar St, Blackfoot, ID 83221-1758 | 2018-07-31 |
| 1023504651 | Amanda Wray | Pharmacist | 98 Poplar St, Blackfoot, ID 83221-1758 | 2018-07-06 |
| 1699268276 | Zachary D Morrow | Nurse Anesthetist, Certified Registered | 98 Poplar St, Blackfoot, ID 83221-1758 | 2018-06-08 |
| 1184115107 | Megan Nicole Broyles | Pharmacist | 98 Poplar St, Blackfoot, ID 83221 | 2018-05-24 |
| 1295223493 | Carolyn Louise Hansen | Nurse Practitioner | 98 Poplar St, Blackfoot, ID 83221-1799 | 2018-04-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932711165 | Samantha Paige Averett | Social Worker | 60 N Broadway, Blackfoot, ID 83221 | 2020-08-19 |
| 1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
| 1962994962 | Tyler Thomas Wood | Student in an Organized Health Care Education/Training Program | 98 Poplar Street, Blackfoot, Id 83221, Blackfoot, ID 83221 | 2018-06-05 |
| 1801336276 | Bmh, Inc. | Internal Medicine | 235 Poplar St, Blackfoot, ID 83221 | 2017-03-03 |
| 1497119804 | Susan Doran | Social Worker | 720 E. Alice, Blackfoot, ID 83221 | 2016-04-12 |
| 1427412121 | Josie Russell Adkins | Counselor | 720 East Alice, Blackfoot, ID 83221 | 2016-04-08 |
| 1740590314 | Ashley Nichole Thomas | Physician Assistant | 710 E. Alice Street, Blackfoot, ID 83221 | 2010-10-18 |
| 1528373313 | Stephanie Lynn Henderson | Dietitian, Registered | 1555 Vernon Ave, Blackfoot, ID 83221 | 2010-08-17 |
| 1184850141 | Joy H. Taylor | Nurse Practitioner | 1441 Parkway Drive, Blackfoot, ID 83221 | 2009-06-04 |
| 1427232925 | Nathan E. Sneddon | Anesthesiology | 98 Poplar St Fl 3, Blackfoot, ID 83221 | 2007-12-20 |
| Find all providers in zip 83221 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245846187 | Adam Baker | Physician Assistant | 271 Jefferson St, Blackfoot, ID 83221-1818 | 2020-09-16 |
| 1326515313 | Vanessa Estella Martinez-quezada | Physician Assistant | 419 W 270 N, Blackfoot, ID 83221-4927 | 2018-10-28 |
| 1720502917 | Alfonso Jr Hernandez | Physician Assistant | 466 Horrocks Dr, Blackfoot, ID 83221-3452 | 2017-07-28 |
| 1740590314 | Ashley Nichole Thomas | Physician Assistant | 710 E. Alice Street, Blackfoot, ID 83221 | 2010-10-18 |
| 1104394337 | Lucas P Belford | Physician Assistant | 700 E Alice St, Blackfoot, ID 83221-4925 | 2018-11-06 |
| 1770002974 | Alan E Crandall | Physician Assistant | 98 Poplar St, Blackfoot, ID 83221-1758 | 2017-09-19 |
| 1679973119 | Danielle Hamill | Physician Assistant | 700 E Alice St, Blackfoot, ID 83221-4925 | 2014-09-03 |
| 1003168899 | John Todd Allen | Physician Assistant | 700 E Alice St, Blackfoot, ID 83221-4925 | 2012-10-04 |
| 1326347972 | Julia Mcgee | Physician Assistant | 98 Poplar St, Blackfoot, ID 83221-1758 | 2011-03-22 |
| 1215237896 | Julie Marie Heier | Physician Assistant | 98 Poplar St, Blackfoot, ID 83221-1758 | 2010-10-28 |
| Find all providers in BLACKFOOT | ||||
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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.