Individual provider Active NPI

Gwen Lorraine McKee, APRN

  • Family Nurse Practitioner
  • Kellogg, ID
National Provider Identifier
1043088222
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
72052 Issued in ID
Practice address
25 Jacobs Gulch Rd
Kellogg, ID 83837-2023
Phone
(208) 784-1221
Fax
(208) 784-0961
NPI assigned
Dec 18, 2023
Last updated
Dec 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 72052 ID Primary
Emergency Registered Nurse 163WE0003X 69340 ID

Addresses

Primary practice location

25 Jacobs Gulch Rd
Kellogg, ID 83837-2023

Mailing address

25 Jacobs Gulch Rd
Kellogg, ID 83837-2023

Other practice location 1

858 Commerce Drive
Smelterville, ID 83868
Phone (208) 784-4612

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240702002408 ID Practitioner - Nurse Practitioner 4587108436 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shoshone Medical CenterGroup PAC ID 6103739107, 15 clinicians

Practice addresses (Care Compare)

858 E Commerce Dr
Smelterville, ID 83868
Phone (208) 784-4612

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
69340IDMDEmergency Registered Nurse
72052IDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shoshone Medical Center CurrentSince Jun 1, 2024 Accepting new patients
Shoshone Medical Center CurrentSince Jun 1, 2024 Accepting new patients

Locations

25 Jacobs Gulch Rd
Kellogg, ID 83837
Phone (208) 784-1221

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/9a0a9763-cc6e-4ca0-bdec-c16291c965b9/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1043088222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 JACOBS GULCH RD",
            "city": "KELLOGG",
            "state": "ID",
            "postal_code": "838372023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 JACOBS GULCH RD",
            "city": "KELLOGG",
            "state": "ID",
            "postal_code": "838372023",
            "telephone_number": "208-784-1221",
            "fax_number": "208-784-0961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "858 Commerce Drive",
            "address_purpose": "LOCATION",
            "city": "Smelterville",
            "state": "ID",
            "postal_code": "83868",
            "country_code": "US",
            "telephone_number": "208-784-4612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKEE",
        "first_name": "GWEN",
        "middle_name": "LORRAINE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-18",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "72052",
            "primary": true
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "ID",
            "license": "69340",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kellogg, ID

Sources for this page

Verify at the official NPI Registry.