Individual provider Active NPI

Samantha Kaitlin Legault, FNP-C

  • Family Nurse Practitioner
  • Boise, ID
National Provider Identifier
1205658978
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
8861276 Issued in ID
Practice address
6933 W Emerald St
Boise, ID 83704-8616
Phone
(208) 321-0634
NPI assigned
Oct 24, 2024
Last updated
Oct 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 8861276 ID Primary

Addresses

Primary practice location

6933 W Emerald St
Boise, ID 83704-8616

Mailing address

7848 W McMullen St
Boise, ID 83709-0839
Phone (208) 353-2928

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
I20241106001119 ID Practitioner - Nurse Practitioner 3779017256 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
All Horizons IncGroup PAC ID 0345377958, 12 clinicians

Practice addresses (Care Compare)

6933 W Emerald St
Boise, ID 83704-8616
Phone 2083210634110

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8861276IDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ricardo Ramirezs Counseling PLLC CurrentSince Oct 24, 2024 Accepting new patients
All Horizons, Inc. CurrentSince Oct 24, 2024 Accepting new patients
All Horizons Inc Current Accepting new patients
All Seasons Mental Health Past Accepting new patients

Locations

6933 W Emerald St
Boise, ID 83704
Phone (208) 321-0634

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1729728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1205658978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7848 W MCMULLEN ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837090839",
            "telephone_number": "208-353-2928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6933 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048616",
            "telephone_number": "208-321-0634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEGAULT",
        "first_name": "SAMANTHA",
        "middle_name": "KAITLIN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-24",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "8861276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.