East Idaho Wound Care LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

EAST IDAHO WOUND CARE LLC

Practice address

1005 Terry Dr
Idaho Falls, ID 83404-5122

Phone

(208) 541-8879

NPI assigned

Jul 15, 2025

Last updated

Jul 15, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Justin Kyler Croft, FNP-CNPI 1821896937

Title

NP

Phone

(208) 541-8879

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Justin Kyler Croft, FNP-C

  • Nurse Practitioner
  • Idaho Falls, ID
  • NPI 1821896937
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1752537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752537600000",
    "number": "1407748510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 TERRY DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834045122",
            "telephone_number": "208-541-8879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 TERRY DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834045122",
            "telephone_number": "208-541-8879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST IDAHO WOUND CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-15",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A",
        "authorized_official_last_name": "CROFT",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "KYLER",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "208-541-8879",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Idaho Center for Sleep LLC
• East Idaho Orthopaedics PLLC (Liljenquist & Redd Orthopedic Surgery)
• East Idaho Orthopaedics, PLLC (Liljenquist & Redd Orthopedic Surgery)
• East Idaho Residential Habilitation LLC
• East Idaho Surgical Assisting, LLC
• East Idaho Youth Homes LLC
• Eastern Idaho Cardiology Associates, PLLC
• Eastern Idaho Chiropractic Clinic PA
• Eastern Idaho Community Action Partnership
• Eastern Idaho Endodontics

• Family Nurse Practitioner in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.