Individual provider Active NPI

Krista Tickemyer, FNP

  • Nurse Practitioner
  • Coeur d'Alene, ID
National Provider Identifier
1114393618
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
N-40239 Issued in ID
Practice address
1919 Lincoln Way Ste 415
Coeur D Alene, ID 83814
Phone
(208) 625-4595
Fax
(208) 625-4596
NPI assigned
Aug 19, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X N-35924 ID
Family Nurse Practitioner 363LF0000X NP-1596A ID
Nurse Practitioner 363L00000X N-40239 ID Primary

Addresses

Primary practice location

1919 Lincoln Way Ste 415
Coeur D Alene, ID 83814

Mailing address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-5059

Other practice location 1

1090 W. Park Place
Coeur d'Alene, ID 83814
Phone (208) 292-0292

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ktickemyer611124@direct.multicare.org

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
I20151002001530 ID Practitioner - Nurse Practitioner 9638487143 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kootenai Health IncGroup PAC ID 1355792276, 394 clinicians

Practice addresses (Care Compare)

1055 Riverside Ave
Orofino, ID 83544-9029
Phone (208) 476-5777

1919 Lincoln Way
Coeur D Alene, ID 83814-2527

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.65 of 100Reported as apm
Quality
89.26
Promoting interoperability
69.9
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
N-40239IDMDNurse Practitioner
NP-1596AIDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kootenai Health, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Kootenai Health, Inc. Nurse Practitioner Current Accepting new patients
Incyte Pathology, PLLC Current Accepting new patients
Kootenai Health, Inc. CurrentSince Feb 25, 2019 Accepting new patients
Kootenai Health, Inc. CurrentSince Feb 25, 2019 Accepting new patients

Locations

1919 Lincoln Way
Ste 416
Coeur D Alene, ID 83814
Phone (208) 625-4595

2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085

1919 Lincoln Way
Ste 415
Coeur D Alene, ID 83814
Phone (208) 625-4595

1300 E Mullan Ave
Ste 700
Post Falls, ID 83854
Phone (208) 625-5564

Interoperability endpoints

  • Direct secure messaging: ktickemyer611124@direct.multicare.org
  • Direct secure messaging: ktickemyer@khgi.gwaydirect.com

Organizations & group practices 5

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

Hospital & facility affiliations 5

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": "1439942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753401600000",
    "number": "1114393618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-5059",
            "fax_number": "208-625-5731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 LINCOLN WAY STE 415",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-625-4595",
            "fax_number": "208-625-4596"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1090 W. Park Place",
            "address_purpose": "LOCATION",
            "city": "Coeur d'Alene",
            "state": "ID",
            "postal_code": "83814",
            "country_code": "US",
            "telephone_number": "208-292-0292",
            "fax_number": "208-292-0705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TICKEMYER",
        "first_name": "KRISTA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-19",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "N-35924",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-1596A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "N-40239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ktickemyer611124@direct.multicare.org",
            "affiliation": "N",
            "address_1": "1919 Lincoln Way Ste 415",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "83814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.