Individual provider Active NPI

Kristina Leeann Liebenthal, FNP-C

  • Family Nurse Practitioner
  • Boise, ID
National Provider Identifier
1538324389
Registry record updated Sep 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
869-A Issued in ID
Practice address
190 E Bannock St
Boise, ID 83712-6241
Phone
(208) 385-3230
Fax
(208) 385-4088
NPI assigned
Jul 22, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 869-A ID Primary

Addresses

Primary practice location

190 E Bannock St
Boise, ID 83712-6241

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 385-3230

Other names 1

  • Ms. Kristina Leeann Unterseher Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, ID, SC3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20081015000044 OR Practitioner - Nurse Practitioner 0244305258 Reassigns benefits to 2 organizations
I20140910001097 ID Practitioner - Nurse Practitioner 0244305258 Reassigns benefits to 2 organizations
I20200227002174 SC Practitioner - Internal Medicine 0244305258 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-9384

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
869-AIDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Jul 27, 2015 Accepting new patients
Cogent Healthcare of Washington, PC CurrentSince Mar 1, 2020 Accepting new patients
South Sound Inpatient Physicians PLLC CurrentSince Mar 1, 2020 Accepting new patients
Vibra Physicians LLC CurrentSince Mar 15, 2018 Accepting new patients
McKenzie Physician Services LLC CurrentSince Jun 15, 2020 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

720 E Park Blvd
Ste 200
Boise, ID 83712
Phone (208) 381-3939

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

100 E Idaho St
Ste 200
Boise, ID 83712
Phone (208) 381-7312

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

2131 S Bonito Way
Meridian, ID 83642
Phone (208) 202-4700

1750 Thompson Rd
Coos Bay, OR 97420
Phone (541) 269-0333

1460 G St
Springfield, OR 97477
Phone (541) 431-0665

1200 Hospital Dr
Mt Pleasant, SC 29464
Phone (843) 226-7721

8081 Royal Ridge Pkwy
Ste 130
Irving, TX 75063
Phone (844) 870-6689

1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818

Interoperability endpoints

  • Direct secure messaging: kunterseher24042@direct.slhs.org
  • Direct secure messaging: kunterse@yourcarecommunity.org
  • Direct secure messaging: kunterseher149631@ummc.direct-ci.com

Organizations & group practices 6

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 2

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": "1216684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1538324389",
    "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",
            "telephone_number": "208-385-3230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-385-3230",
            "fax_number": "208-385-4088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBENTHAL",
        "first_name": "KRISTINA",
        "middle_name": "LEEANN",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-22",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "869-A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "UNTERSEHER",
            "middle_name": "LEEANN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.