Active NPI
Lisa Wilmore
- Marriage & Family Therapist
- Ammon, ID
National Provider Identifier
1336687805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 3522 Briar Creek LN
Ammon, ID 83406-4728 - Phone
- (208) 529-1660
- NPI assigned
- Feb 5, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
3522 Briar Creek LN
Ammon, ID 83406-4728
Mailing address
1900 Parkwood St
Apt #C305
Idaho Falls, ID 83401-6132
Phone (616) 540-8348
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 112520007 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493164800000",
"number": "1336687805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 PARKWOOD ST",
"address_2": "APT #C305",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834016132",
"telephone_number": "616-540-8348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3522 BRIAR CREEK LN",
"city": "AMMON",
"state": "ID",
"postal_code": "834064728",
"telephone_number": "208-529-1660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILMORE",
"first_name": "LISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-05",
"last_updated": "2017-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "112520007",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ammon, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.