Crystal Gail Belcourt, CPNP-PC
Individual provider Active NPI Pediatric Nurse Practitioner · Caldwell, ID
NPI 1194226837 · NPPES record last updated May 8, 2018
Key facts
- NPI
- 1194226837
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 58461 (ID)
- Practice address
- 1620 S Kimball Ave
Caldwell, ID 83605-4547 - Phone
- (208) 505-2950
- Fax
- (208) 505-2955
- NPI assigned
- Feb 27, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58461 | ID | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Regional Medical Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 58461 | ID | Yes |
Addresses
Primary practice location
1620 S Kimball Ave
Caldwell, ID 83605-4547
Mailing address
684 Franklin Ave
Kuna, ID 83634-2025
Phone (208) 871-9579
Other providers in Caldwell, ID
- Gerald Charles Bauman
- Karen Ann Bean
- Kimberly Beebe
- Michelle Beers
- Joshua Befus
- Bell Chemical Dependency Ounseling Inc.
- Adam D. Bell
- Anai Bell
- Diana M Bell
- Monica J Bell
All providers in Caldwell, ID · Pediatric Nurse Practitioner in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.