Pocatello Wellness Clinic, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

POCATELLO WELLNESS CLINIC, LLC

Practice address

1155 Yellowstone Ave
Ste D
Pocatello, ID 83201-4369

Phone

(208) 637-9610

Fax

(208) 238-6162

NPI assigned

Feb 20, 2019

Last updated

Apr 23, 2024By 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

Dustin Reno, NPNPI 1568906865

Title

Owner

Phone

(208) 637-9610

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 6

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.

• Dustin Reno, NP-C

  • Family Nurse Practitioner
  • Pocatello, ID
  • NPI 1568906865
  Medicare reassignment Care Compare group NPD Authorized official
• Jason Knighton, NP-C

  • Family Nurse Practitioner
  • Pocatello, ID
  • NPI 1285199869
  Medicare reassignment Care Compare group NPD
• Kayloni C Christensen, NP

  • Family Nurse Practitioner
  • Pocatello, ID
  • NPI 1134987597
  Medicare reassignment NPD
• McKenzie Hoggan, BSN, MSN, WHNP-BC

  • Women's Health Nurse Practitioner
  • Pocatello, ID
  • NPI 1437083755
  NPD
• Jessicka Lynn Price, FNP

  • Family Nurse Practitioner
  • Pocatello, ID
  • NPI 1184257818
  NPD
• Margaret Elizabeth Jablonski, NP-C

  • Family Nurse Practitioner
  • Pocatello, ID
  • NPI 1700491933
  NPD (past)

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

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713830400000",
    "number": "1437615952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 YELLOWSTONE AVE",
            "address_2": "STE D",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014369",
            "telephone_number": "208-637-9610",
            "fax_number": "208-238-6162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 YELLOWSTONE AVE",
            "address_2": "STE D",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014369",
            "telephone_number": "208-637-9610",
            "fax_number": "208-238-6162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCATELLO WELLNESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-20",
        "last_updated": "2024-04-23",
        "certification_date": "2020-03-17",
        "status": "A",
        "authorized_official_last_name": "RENO",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-637-9610",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pocatello Physical Therapy
• Pocatello Physical Therapy Clinic PA
• Pocatello Podiatry Associates PA (Ambulatory Foot and Ankle Clinic)
• Pocatello Pulmonary PC
• Pocatello Rehabilitation PA
• Jacie Jean Pollard, M.S., CCC-SLP
• Rick Pongratz, PH.D.
• Justin C Pool, PA-C
• Ryan Pope, DPT
• Bonnie Porter, BA

• Family Nurse Practitioner in Pocatello, ID
• Providers in Pocatello, 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 Apr 23, 2024; 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.