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1568255636 NPI number — WESTERN SKIES WELLNESS AND PRIMARY CARE, P.C.

NPI Number: 1568255636
Health Care Provider/Practitioner: WESTERN SKIES WELLNESS AND PRIMARY CARE, P.C.

Information about “1568255636” NPI (WESTERN SKIES WELLNESS AND PRIMARY CARE, P.C.) exists in 1568255636 in HTML format HTML  |  1568255636 in plain Text format TXT  |  1568255636 in PDF (Portable Document Format) PDF  |  1568255636 in an XML format XML  formats.

NPI Number : 1568255636 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568255636",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WESTERN SKIES WELLNESS AND PRIMARY CARE, P.C.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 158",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COUNCIL",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83612-0158",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-849-3725",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "119 ILLINOIS AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COUNCIL",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83612-7709",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-849-3725",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/22/2025",
    "LastUpdateDate": "05/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HANEY",
    "AuthorizedOfficialFirstName": "JODI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CREDENTIALING/CONTRACTING",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "541-410-5394",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LG0600X",
        "TaxonomyName": "Gerontology Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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