Amanda Marie Tillemans, NURSE PRACTITIONER

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

68559 Issued in ID

Practice address

13500 S Pleasant Valley Rd
Kuna, ID 83634-2709

Phone

(208) 336-0740

NPI assigned

Jun 30, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Amanda Marie Benton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Evolving Minds Mental Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Nampa, ID
  • NPI 1326821620
  NPD Authorized official

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

{
    "created_epoch": "1625011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1548830573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 S BEVERLY ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837094907",
            "telephone_number": "775-247-7624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13500 S PLEASANT VALLEY RD",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "836342709",
            "telephone_number": "208-336-0740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLEMANS",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-30",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "68559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "BENTON",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stacia Taplin, L.M., CPM
• Anthony Thiros, DO
• Taylor Ann Thomas, MS., CCC-SLP
• William Thompson, PHARMD
• Denni Tiegs
• Julie Trana, LPC
• Treasure Valley in-Home Care LLC
• Brady Tucker, PHARM D
• Tyler Sykes DMD PLLC
• Rex O Underwood II, RN

• Psychiatric/Mental Health Nurse Practitioner in Kuna, ID
• Providers in Kuna, ID by specialty
• Psychiatric/Mental Health Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; 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.