Victoria S Holdeman

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

57304 Issued in ID

Practice address

4311 E 65TH S
Idaho Falls, ID 83406-8127

Phone

(208) 970-2027

NPI assigned

Mar 29, 2021

Sex

Female

Sole proprietor

Yes

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 ID

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

Certified Nurse Specialist

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1376121848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4311 E 65TH S",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834068127",
            "telephone_number": "208-970-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4311 E 65TH S",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834068127",
            "telephone_number": "208-970-2027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDEMAN",
        "first_name": "VICTORIA",
        "middle_name": "S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-29",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "57304",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "57304",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Jon Hoffmann
• Jacki Hogan, CNA
• Megan Hogan
• Benjamin Loren Hogenson, LMSW
• Debra Hogg, M.S. CCC-SLP
• Hailey Holland, LMSW
• Joe Holland
• Juliette Ann Hollingshead, FNP-C
• Brent Holloway
• Charlene Anne Holloway, LMSW

• Psychiatric/Mental Health Nurse Practitioner in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Psychiatric/Mental Health Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.