Lily Pad Wellness, LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

LILY PAD WELLNESS, LLC

Practice address

1951 Bench Rd Ste a
Pocatello, ID 83201-2073

Phone

(208) 549-7385

Fax

(208) 216-6761

NPI assigned

Jul 27, 2023

Organization subpart

No

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

Authorized official

Name

Stephanie A Clark, NPNPI 1912288572

Title

Owner

Phone

(208) 549-7385

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephanie Clark, NP

  • Nurse Practitioner
  • Pocatello, ID
  • NPI 1912288572
  NPD Authorized official

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

{
    "created_epoch": "1690416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690416000000",
    "number": "1275214660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1951 BENCH RD STE A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012073",
            "telephone_number": "208-549-7385",
            "fax_number": "208-216-6761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1951 BENCH RD STE A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012073",
            "telephone_number": "208-549-7385",
            "fax_number": "208-216-6761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILY PAD WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-27",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-549-7385",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.