Active NPI
Suzanne Keele Edelman, ANP
- Psychiatric/Mental Health Nurse Practitioner
- Moore, ID
National Provider Identifier
1164628442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- NP-325A
- Practice address
- 4702 W Cherry Creek Road
Moore, ID 83255 - Phone
- (208) 554-2006
- NPI assigned
- Jun 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Nurse Practitioner | 363LC1500X | NP-325A | ID | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | NP-325A | ID | Primary |
Addresses
Primary practice location
4702 W Cherry Creek Road
Moore, ID 83255
Mailing address
421 Memorial Dr
Pocatello, ID 83201-4008
Phone (208) 554-2006
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP-325A | Other | ID | ANP LICENSE |
| N-10732 | Other | ID | RN LICENSE |
| ME1563990 | Other | ID | CONTROLLED SUBSTANCE REG. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP-325A | ID | MD | Community Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1164628442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "421 MEMORIAL DR",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014008",
"telephone_number": "208-554-2006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4702 W CHERRY CREEK ROAD",
"city": "MOORE",
"state": "ID",
"postal_code": "83255",
"telephone_number": "208-554-2006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDELMAN",
"first_name": "SUZANNE",
"middle_name": "KEELE",
"credential": "ANP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-25",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LC1500X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Community Health",
"state": "ID",
"license": "NP-325A",
"primary": false
},
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "ID",
"license": "NP-325A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANP LICENSE",
"identifier": "NP-325A",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LICENSE",
"identifier": "N-10732",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONTROLLED SUBSTANCE REG.",
"identifier": "ME1563990",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moore, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.