Kidist Fisseha

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9115682-4405 Issued in UT

Practice address

1633 W Innovation Way FL 4
Lehi, UT 84043-4252

Phone

(855) 726-6363

Fax

(801) 784-1482

NPI assigned

May 19, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

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.

• Wellbe Utah LLC

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1568183523

  UT

  Medicare reassignment NPD

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

{
    "created_epoch": "1684454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1356032262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1633 W INNOVATION WAY FL 4",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840434252",
            "telephone_number": "855-726-6363",
            "fax_number": "801-784-1482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1633 W INNOVATION WAY FL 4",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840434252",
            "telephone_number": "855-726-6363",
            "fax_number": "801-784-1482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISSEHA",
        "first_name": "KIDIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-19",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "1009883",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "9115682-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Fernandez, MS, RD
• Daniel C Fernelius, FNP-C
• D Terry Ferrell, DDS
• Figtree Mental Health Services
• Daniel B Fisher, DPT, OCS, FAAOMPT
• Joseph Richard Fitzgerald, CRNA
• Emily Flake
• Alexandria Fletcher
• Jacob Fletcher, LCMHC
• Flexality Inc Dba Alpine Professional Counseling

• Family Nurse Practitioner in Lehi, UT
• Providers in Lehi, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; 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.