Active NPI
Patricia Sutherland
- Midwife
- Kimberly, ID
National Provider Identifier
1376019547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- MID-91
- Practice address
- 622 Center St W
Kimberly, ID 83341-1720 - Phone
- (208) 490-0203
- NPI assigned
- Oct 16, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Midwife | 176B00000X | MID-91 | ID | Primary |
Addresses
Primary practice location
622 Center St W
Kimberly, ID 83341-1720
Mailing address
3636 N 3600 E
Kimberly, ID 83341-5321
Phone (208) 490-0203
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MID-91 | ID | MD | Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539648000000",
"number": "1376019547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3636 N 3600 E",
"city": "KIMBERLY",
"state": "ID",
"postal_code": "833415321",
"telephone_number": "208-490-0203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "622 CENTER ST W",
"city": "KIMBERLY",
"state": "ID",
"postal_code": "833411720",
"telephone_number": "208-490-0203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTHERLAND",
"first_name": "PATRICIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-16",
"last_updated": "2018-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "ID",
"license": "MID-91",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kimberly, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.