Healthcare Provider Details

I. General information

NPI: 1518813245
Provider Name (Legal Business Name): FPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 WASHINGTON ST N
TWIN FALLS ID
83301-3802
US

IV. Provider business mailing address

955 OAKRIDGE RD
KIMBERLY ID
83341-1818
US

V. Phone/Fax

Practice location:
  • Phone: 208-420-1830
  • Fax:
Mailing address:
  • Phone: 208-420-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL KENNETH WUCINICH
Title or Position: PRESIDENT/PHYSICIAN ASSISTANT
Credential: PA-C, MPH
Phone: 208-420-1830