Evan White

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Practice address

9825 Mayberry LN
Emmett, ID 83617-3051

Phone

(208) 713-1290

NPI assigned

Sep 27, 2024

Last updated

Sep 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1727395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1043038268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9825 MAYBERRY LN",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836173051",
            "telephone_number": "208-713-1290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9825 MAYBERRY LN",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836173051",
            "telephone_number": "208-713-1290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "EVAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-27",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Warren Willis DMD P.C. (Emmett Dental Group P.C.)
• Laura Ann Watson, LCSW
• Lisa Watson, LMSW, LCSW
• Ty C Weber, FNP-C
• Shane Weideman
• Sara Marie Williams
• Warren Richard Willis, D.M.D
• Robin Wood Reed, LCSW
• Thomas Whalen Woodward, O.D.
• Jim E. Young, RPH

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Emmett, ID
• Providers in Emmett, ID by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.