NPIMap

Individual provider Active NPI

Debra Colleen Mykkanen, FNP

  • Family Nurse Practitioner
  • Coeur d'Alene, ID
National Provider Identifier
1548346935
Registry record updated Dec 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP306A Issued in ID
Practice address
700 W Ironwood Dr
Suite 155
Coeur D Alene, ID 83814-2656
Phone
(208) 667-0585
Fax
(208) 667-0876
NPI assigned
Oct 27, 2006
Last updated
Dec 18, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2013

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 NP306A ID Primary

Addresses

Primary practice location

700 W Ironwood Dr
Suite 155
Coeur D Alene, ID 83814-2656

Mailing address

700 W Ironwood Dr
Suite 155
Coeur D Alene, ID 83814-2656
Phone (208) 667-0585

Other identifiers 8

IdentifierTypeStateIssuer
9645896MedicaidWA
NP772IDMedicaidAK
NPKN7OtherIDBLUE CROSS
000010016720OtherIDREGENCE BLUE SHIELD
000010016721OtherIDREGENCE BLUE SHIELD
NPPR4OtherIDBLUE CROSS OF IDAHO
004376300MedicaidID
1548346935MedicaidMT

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
NP306AIDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dirne Health Centers Inc Past Accepting new patients
Coeur D'Alene Pediatrics PA PastSince Apr 2, 2016 Accepting new patients
Dirne Health Centers Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: debbie.mykkanen@cdapeds.directbygreenway.com
  • Direct secure messaging: dmykkanen627382@direct.multicare.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387324800000",
    "number": "1548346935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR",
            "address_2": "SUITE 155",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142656",
            "telephone_number": "208-667-0585",
            "fax_number": "208-667-0876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR",
            "address_2": "SUITE 155",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142656",
            "telephone_number": "208-667-0585",
            "fax_number": "208-667-0876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYKKANEN",
        "first_name": "DEBRA",
        "middle_name": "COLLEEN",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2013-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP306A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9645896",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP772ID",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "NPKN7",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010016720",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010016721",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "NPPR4",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004376300",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548346935",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.