Molly Vaughan Prengaman, APN, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP443A Issued in ID

Practice address

2308 N Cole Rd
Suite H
Boise, ID 83704-7361

Phone

(208) 375-8806

Fax

(208) 375-8826

NPI assigned

Jul 20, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20689/brand/1/csg/1/fhir/r4
• Direct secure messaging: molly.prengaman.1@20689.direct.athenahealth.com

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.

• Southwest District Health

  • Public Health or Welfare Agency
  • Caldwell, ID
  • NPI 1598748337
  Medicare reassignment NPD
• Southwest District Health

  • Public Health or Welfare Agency
  • Caldwell, ID
  • NPI 1689820375
  NPD
• Orthopedic Centers of Idaho P a

  • Orthopaedic Surgery Physician
  • Boise, ID
  • NPI 1487746541
  NPD (past)
• Sonshine Family Health Clinic, LLC

  • Clinic/Center
  • Boise, ID
  • NPI 1669682381

  Family

  NPD (past)
• State of Idaho

  • Low Vision Rehabilitation Optometrist
  • Boise, ID
  • NPI 1801833454
  NPD (past)

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184889600000",
    "number": "1255531976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2308 N COLE RD",
            "address_2": "SUITE H",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837047361",
            "telephone_number": "208-375-8806",
            "fax_number": "208-375-8826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2308 N COLE RD",
            "address_2": "SUITE H",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837047361",
            "telephone_number": "208-375-8806",
            "fax_number": "208-375-8826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENGAMAN",
        "first_name": "MOLLY",
        "middle_name": "VAUGHAN",
        "credential": "APN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-20",
        "last_updated": "2007-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP443A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8050180",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premier Physical Therapy Inc
• Premier Surgical Center, Inc
• Premiere Case Management
• Premise Health of Colorado Medical, P.C.
• Premium Support Services Inc
• Robyn Prentice, LCSW
• Morgan Press, PSY.D., LPC
• Prestige Worldwide LPB LLC
• Preston-Wood and Associates, LLC
• Price Chiropractic Center Chartered

• Family Nurse Practitioner in Boise, ID
• Providers in Boise, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.