Lifespan Primary Care LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP717A Issued in ID

Legal business name

LIFESPAN PRIMARY CARE LLC

Practice address

224 Martin St
Suite B
Twin Falls, ID 83301-4542

Phone

(208) 736-7090

Fax

(208) 736-7089

NPI assigned

Nov 13, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Beverly Ann Hall, FNP-C

Title

Owner

Phone

(208) 736-7090

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023189800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 MARTIN ST",
            "address_2": "SUITE B",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014542",
            "telephone_number": "208-736-7090",
            "fax_number": "208-736-7089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 MARTIN ST",
            "address_2": "SUITE B",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014542",
            "telephone_number": "208-736-7090",
            "fax_number": "208-736-7089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-736-7090",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP717A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.