MEDICARE: KIDCIERGE 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	363LF0000X	Family Nurse Practitioner
2	363LP0200X	Pediatric Nurse Practitioner

General Provider Information

NPI Number	:	1710818059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDCIERGE PLLC

Provider Business Mailing Address
First Line	:	271 S RICHARDS RD
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-4863
Country	:	US
Telephone Number	:	509-998-8210
Fax Number	:

Provider Business Practice Location Address
First Line	:	271 S RICHARDS RD
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-4863
Country	:	US
Telephone Number	:	509-998-8210
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	AUBREY BOT
Credential	:	ARNP
Telephone Number	:	509-998-8210

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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