Individual provider Active NPI

Andrew Tietjen, FNP

  • Nurse Practitioner
  • Boise, ID
National Provider Identifier
1427859164
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5871656 Issued in ID
Practice address
6051 W Emerald St
Boise, ID 83704-8969
Phone
(208) 302-5150
Fax
(208) 302-5155
NPI assigned
Mar 20, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Nurse Practitioner 363L00000X 5871656 ID Primary

Addresses

Primary practice location

6051 W Emerald St
Boise, ID 83704-8969

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-5170

Other practice location 1

10583 W Lake Hazel Rd
Boise, ID 83709-6326
Phone (208) 302-5950

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250606000001 ID Practitioner - Nurse Practitioner 1456861830 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10583 W Lake Hazel Rd
Boise, ID 83709-6326
Phone (208) 302-5900

10717 W State St
Star, ID 83669-6046
Phone (208) 302-6300

11035 Karcher Rd
Nampa, ID 83651-8200
Phone (208) 302-2100

1150 N Sister Catherine Way
Nampa, ID 83687-3133
Phone (208) 302-7000

1510 12TH Ave Rd
Suite 200
Nampa, ID 83686-6008
Phone (208) 302-6899

1512 12TH Ave Rd
Suite 100
Nampa, ID 83686-6008
Phone (208) 467-1171

215 E Hawaii Ave
Nampa, ID 83686-6011

3025 W Cherry LN
Meridian, ID 83642-8531

6022 W Emerald St
Boise, ID 83704-8855
Phone (208) 367-4603

6051 W Emerald St
Boise, ID 83704-8969
Phone (208) 302-5100

6094 W Emerald St
Boise, ID 83704-8855
Phone (208) 302-1000

712 Aviation Way
Caldwell, ID 83605-1154
Phone (208) 302-1035

757 E Wythe Creek CT
Suite 100
Kuna, ID 83634-5006
Phone (208) 302-6500

867 S Vanguard Way
Meridian, ID 83642-7552
Phone (208) 302-7950

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5871656IDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Jul 1, 2025 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Nurse Practitioner Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Jul 1, 2025 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Jul 1, 2025 Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Jul 1, 2025 Accepting new patients

Locations

6051 W Emerald St
Boise, ID 83704
Phone (208) 302-5100

10583 W Lake Hazel Rd
Boise, ID 83709
Phone (208) 302-5900

910 NW 16th St
Ste 101
Fruitland, ID 83619
Phone (208) 452-8000

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

Organizations & group practices 5

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1742428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747958400000",
    "number": "1427859164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-5170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6051 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048969",
            "telephone_number": "208-302-5150",
            "fax_number": "208-302-5155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10583 W Lake Hazel Rd",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837096326",
            "country_code": "US",
            "telephone_number": "208-302-5950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIETJEN",
        "first_name": "ANDREW",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-20",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "5871656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.