NPIMap

Individual provider Active NPI

Amie Beth Kenyen, NP-C

  • Nurse Practitioner
  • Pocatello, ID
National Provider Identifier
1114569282
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
62679 Issued in ID
Practice address
444 Hospital Way Ste 607
Pocatello, ID 83201-2714
Phone
(208) 589-3844
NPI assigned
Oct 10, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 62679 ID Primary

Addresses

Primary practice location

444 Hospital Way Ste 607
Pocatello, ID 83201-2714

Mailing address

3592 Nathan Dr
Idaho Falls, ID 83404-7948
Phone (208) 589-3844

Other practice location 1

2375 E Sunnyside Rd Ste F
Idaho Falls, ID 83404-8281
Phone (208) 589-3844

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200214001282 ID Practitioner - Nurse Practitioner 1658706700 Reassigns benefits to 2 organizations
I20210702000925 OR Practitioner - Nurse Practitioner 1658706700 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Clair Specialty Physicians PCGroup PAC ID 6204733256, 36 clinicians

Practice addresses (Care Compare)

515 E LN S
Ontario, OR 97914-3953
Phone (208) 501-8955

5610 W Gage St
Suite a
Boise, ID 83706-1332
Phone (208) 367-3370

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071
  • Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013
  • West Valley Medical Center Hospital, Caldwell, ID, CCN 130014

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health, LLC Nurse Practitioner CurrentSince Mar 1, 2021 Accepting new patients
St Clair Specialty Physicians PC CurrentSince Apr 20, 2021 Accepting new patients
Idaho Nephrology Associates, L.L.C Past Accepting new patients

Locations

950 W Bannock St
Ste 1100
Boise, ID 83702
Phone (201) 293-7689

5610 W Gage St
Ste A
Boise, ID 83706
Phone (208) 367-3370

1818 S 10th Ave
Ste 120
Caldwell, ID 83605
Phone (208) 468-5959

1210 NW 16th St
Fruitland, ID 83619
Phone (208) 452-8600

45640 Schoenherr Rd
Utica, MI 48315
Phone (586) 247-4300

45640 Schoenherr Rd
Ste B
Utica, MI 48315
Phone (586) 247-4300

515 East Ln S
Ontario, OR 97914
Phone (208) 501-8955

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Interoperability endpoints

  • Direct secure messaging: amiekenyen@stclairspe.allscriptsdirect.net

Organizations & group practices 3

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 11

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": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1114569282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3592 NATHAN DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047948",
            "telephone_number": "208-589-3844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 HOSPITAL WAY STE 607",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012714",
            "telephone_number": "208-589-3844"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2375 E Sunnyside Rd Ste F",
            "address_purpose": "LOCATION",
            "city": "Idaho Falls",
            "state": "ID",
            "postal_code": "834048281",
            "country_code": "US",
            "telephone_number": "208-589-3844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENYEN",
        "first_name": "AMIE",
        "middle_name": "BETH",
        "name_prefix": "Ms.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-10",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "62679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.