Kailyn Wiersma

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

M-16194 Issued in ID

Practice address

1620 S Celebration Ave
Meridian, ID 83642-2779

Phone

(208) 884-1030

NPI assigned

May 17, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058

  Pediatrics

  Medicare reassignment NPD
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  NPD (past)
• Regents of the University of Michigan

  • Home Health Agency
  • Ann Arbor, MI
  • NPI 1063465607
  NPD (past)

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

{
    "created_epoch": "1494979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1508393976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 S CELEBRATION AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422779",
            "telephone_number": "208-884-1030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 E Medical Center Dr Spc 5718",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481095718",
            "country_code": "US",
            "telephone_number": "734-763-5589",
            "fax_number": "734-763-4208",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Arnet St",
            "address_purpose": "LOCATION",
            "city": "Ypsilanti",
            "state": "MI",
            "postal_code": "481985753",
            "country_code": "US",
            "telephone_number": "734-484-7288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIERSMA",
        "first_name": "KAILYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-17",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301501833",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301112092",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M-16194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aimee Wicker, PHARM.D.
• Jennifer Wicklund, FNP-C
• Catherine Wickstrum
• Ted Wiedmann, PHARMD
• Lindsay Rose Wienand, RN
• Emily Wiese, PA-C
• Drew Riley Wiesemann
• Mark David Wigod, MD
• Linda M Wiklund, COTA/L
• Joshua Keith Wilding, PA-C

• Pediatrics Physician in Meridian, ID
• Providers in Meridian, ID by specialty
• Pediatrics Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; 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.