MEDICARE: ORIGIN HEALTH & LONGEVITY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1174453757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORIGIN HEALTH & LONGEVITY PLLC

Provider Business Mailing Address
First Line	:	4686 N ALAMEDA CREEK AVE
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-2017
Country	:	US
Telephone Number	:	208-283-4929
Fax Number	:

Provider Business Practice Location Address
First Line	:	4686 N ALAMEDA CREEK AVE
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-2017
Country	:	US
Telephone Number	:	208-283-4929
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAMUEL KENT BUTTARS
Credential	:	NP
Telephone Number	:	208-283-4929

Provider Enumeration Date	:	05/23/2026
Last Update Date	:	05/23/2026

Similar Medicare Providers

1225484587 — RIKI EVANS CNC
Practice Location Address:

2017 W BOULDER BAR DR
MERIDIAN, ID
83646-5945

Practice Phone: 208-475-4500
Practice Fax:

1629947635 — SAMUEL KENT BUTTARS FNP
Practice Location Address:

4686 N ALAMEDA CREEK AVE
MERIDIAN, ID
83646-2017

Practice Phone: 208-283-4929
Practice Fax:

1215911920 — DR. TIMOTHY A HANSEN DDS
Practice Location Address:

4702 N PENNGROVE WAY STE 100
MERIDIAN, ID
83646-7449

Practice Phone: 208-938-1825
Practice Fax: 208-938-5763

1164374765 — AARON L FARLEY
Practice Location Address:

1400 W CHINDEN BLVD
MERIDIAN, ID
83646-5328

Practice Phone: 208-893-6033
Practice Fax:

1023940665 — STEPHANIE MARIAH SANDERS LPC MASTERS INTERN
Practice Location Address:

1500 W CAYUSE CREEK DR STE 175
MERIDIAN, ID
83646-4756

Practice Phone: 208-273-1842
Practice Fax:

1396677902 — KAROL HANSON RD
Practice Location Address:

2052 N LARK PL
MERIDIAN, ID
83646-3326

Practice Phone: 669-285-7253
Practice Fax:

Directions to “ORIGIN HEALTH & LONGEVITY PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.