Emily Jardine

Key facts

NPI

1558100511

Entity type

Individual (NPI type 1)

Primary specialty

Student in an Organized Health Care Education/Training Program 390200000X

Practice address

875 Perimeter Dr
Moscow, ID 83844-9803

Phone

(208) 885-6111

NPI assigned

May 21, 2024

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 29, 2024.

{
    "created_epoch": "1716249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719619200000",
    "number": "1558100511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1323 N 2375 W",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840417738",
            "telephone_number": "801-834-8633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 PERIMETER DR",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838449803",
            "telephone_number": "208-885-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JARDINE",
        "first_name": "EMILY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-21",
        "last_updated": "2024-06-29",
        "certification_date": "2024-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225500000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moscow, ID

• Alyda Rose Jaegerman, LMSW
• Lynley R James, NP-C
• Whitney Marie James
• Nelson Jamir
• Patrick Joseph Jamsa
• Joel Theodore Jaureguito, D.C.
• Aubrie Jeansonne
• Tiarra Jeff
• Tucker Jeppson, DO
• John a Werner PLLC

All providers in Moscow, ID · Student in an Organized Health Care Education/Training Program in Idaho