Active NPI
Kevin Pendlebury, CDE
- Diabetes Educator Registered Nurse
- Fort Hall, ID
National Provider Identifier
1528209129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diabetes Educator Registered Nurse
- License
- 2061-0302
- Practice address
- Mission Rd
Fort Hall, ID 83203-0306 - Phone
- (208) 238-2400
- Fax
- (208) 238-5462
- NPI assigned
- Mar 12, 2009
- Last updated
- Mar 12, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | N31309 | ID | |
| Diabetes Educator Registered Nurse | 163WD0400X | 2061-0302 | IL | Primary |
Addresses
Primary practice location
Mission Rd
Fort Hall, ID 83203-0306
Mailing address
PO Box 306
Fort Hall, ID 83203-0306
Phone (208) 238-2400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003399100 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N31309 | ID | MD | Registered Nurse |
| 2061-0302 | IL | MD | Diabetes Educator Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236816000000",
"number": "1528209129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 306",
"city": "FORT HALL",
"state": "ID",
"postal_code": "832030306",
"telephone_number": "208-238-2400",
"fax_number": "208-238-5462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MISSION RD",
"city": "FORT HALL",
"state": "ID",
"postal_code": "832030306",
"telephone_number": "208-238-2400",
"fax_number": "208-238-5462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDLEBURY",
"first_name": "KEVIN",
"credential": "CDE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-03-12",
"last_updated": "2009-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "ID",
"license": "N31309",
"primary": false
},
{
"code": "163WD0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Diabetes Educator",
"state": "IL",
"license": "2061-0302",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003399100",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Hall, ID
- Not Tsoo Gah Nee Indian Health Services
- Not-Tsoo Gah-Nee Indian Health Center
- Not-Tsoo Gah-Nee Indian Health Center Pharmacy
- Not-Tsoo Gah-Nee Indiane Health Services
- Sandra Ortiz, ICADC
- James Picanco Sr., P.A.-C
- Brandy Pugmire, PN
- Nava Reneda, CADC
- Catherine Tammy Salisbury, R.D.H.
- Shoshone Bannock Hotel & Event Center (Cedar Spa)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.