Korena Popp FNP Medical Services LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

KORENA POPP FNP MEDICAL SERVICES LLC

Doing business as

The Change Clinic

Practice address

454 W Roseberry Rd. Ste 104
Donnelly, ID 83615-8361

Phone

(208) 325-3500

Fax

(208) 325-3501

NPI assigned

Jul 17, 2019

Last updated

Jul 17, 2019By 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

Korena Lynn Popp

Title

NP

Phone

(208) 325-3500

Specialties & licenses 1

Addresses

Other names 1

• The Change Clinic Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1563321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563321600000",
    "number": "1093368276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 172",
            "city": "DONNELLY",
            "state": "ID",
            "postal_code": "836150172",
            "telephone_number": "208-325-3500",
            "fax_number": "208-325-3501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 W ROSEBERRY RD. STE 104",
            "city": "DONNELLY",
            "state": "ID",
            "postal_code": "836158361",
            "telephone_number": "208-325-3500",
            "fax_number": "208-325-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KORENA POPP FNP MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-17",
        "last_updated": "2019-07-17",
        "status": "A",
        "authorized_official_last_name": "POPP",
        "authorized_official_first_name": "KORENA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "208-325-3500"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.facebook.com/TheChangeClinic/",
            "affiliation": "N",
            "endpointDescription": "business email",
            "address_1": "454 W Roseberry Rd. Ste 104",
            "city": "Donnelly",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836158361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Change Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Margaux Crockett
• Donnelly Rural Fire Protection District
• Susan K Drake, MD, RDN
• Getto Counseling and Consulting, LLC
• Kelly Companies, LLC (Mountain Valley Counseling & Outdoor Therapy)
• Annalee Mangum, RN
• McCall Memorial Hospital (Donnelly Medical Clinic, a MMH Physician Clinic)
• Mountain Mobile Medicine, PLLC
• Payette Lakes Medical Clinic, PA
• Taylor Rae, P-LCSW

• Clinic/Center in Donnelly, ID
• Providers in Donnelly, ID by specialty
• Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; 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.