Verlyn Glenn, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Meridian, ID
NPI 1306600523 · NPPES record last updated Jul 13, 2024
Key facts
- NPI
- 1306600523
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 2861262 (ID)
- Practice address
- 1833 S Millenium Way Ste 100
Meridian, ID 83642-1510 - Phone
- (509) 828-8307
- NPI assigned
- Feb 8, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240924001388 | ID | Practitioner - Nurse Practitioner | 2062953599 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66417 | ID | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Citadel Mental Health LLC | Current |
Accepting new patients |
Locations
1833 S Millenium Way
#100
Meridian, ID 83642
Phone (208) 614-3637
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 66417 | ID | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 2861262 | ID | Yes |
Addresses
Primary practice location
1833 S Millenium Way Ste 100
Meridian, ID 83642-1510
Mailing address
1711 W Wood Chip St
Meridian, ID 83642-7322
Phone (509) 828-8307
Other providers in Meridian, ID
- Mary Ginnetti
- Emily Gire
- Haley Givvines
- GJC Enterprises, Inc
- Randall Francis Glenn
- John Glisson
- Gloria M Beery, CNP
- Erika C Glover
- Claudia C Glovier
- Gretchen A Glynn
All providers in Meridian, ID · Psychiatric/Mental Health 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 Jul 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.