Tawni Peterson

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

54458 Issued in ID

Practice address

205 N Berkley St
Council, ID 83612

Phone

(208) 250-0970

NPI assigned

Feb 24, 2016

Last updated

Mar 16, 2017By the provider in NPPES

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

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Adams County Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Council, ID
  • NPI 1710915897
  Medicare reassignment NPD
• Regenerize Psychiatry PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sandpoint, ID
  • NPI 1043054075
  NPD (past)

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

{
    "created_epoch": "1456272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489622400000",
    "number": "1508226226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 560",
            "city": "NEW MEADOWS",
            "state": "ID",
            "postal_code": "836540560",
            "telephone_number": "209-825-0097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N BERKLEY ST",
            "city": "COUNCIL",
            "state": "ID",
            "postal_code": "83612",
            "telephone_number": "208-250-0970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TAWNI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-24",
        "last_updated": "2017-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "ID",
            "license": "54458",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "N-45114",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Kimpel, PA-C
• Douglas M. Linford, DO
• Mountains West Dental PLLC
• Valeda A Murray
• Payette Lakes Medical Clinic, PA
• Kenneth Charles Prince, DDS
• Proactive Physical Therapy of McCall, PA
• Rogue River Sleep Dentistry
• Lisa H Shine, LMSW
• Mikayla Raylynn Shumway, RN

• Primary Care Nurse Practitioner in Council, ID
• Providers in Council, ID by specialty
• Primary Care Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; 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.