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General NPI Number Information
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NPI Number | 1518813245
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Entity Type | Organization
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Legal Business Name | FPM PLLC
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 585 WASHINGTON ST N
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City | TWIN FALLS
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State | ID
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Zip | 83301-3802
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Country | US
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Telephone | 208-420-1830
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Fax |
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Provider Business Mailing Address
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Address Line | 955 OAKRIDGE RD
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City | KIMBERLY
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State | ID
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Zip | 83341-1818
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Country | US
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Telephone | 208-420-1830
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN ASSISTANT
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Name | MR. MICHAEL KENNETH WUCINICH
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Credential | PA-C, MPH
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Telephone | 208-420-1830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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