Individual provider Active NPI

Brennan N Carmody, NP

  • Nurse Practitioner
  • Meridian, ID
National Provider Identifier
1629400734
Registry record updated Feb 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP1318A Issued in ID
Practice address
176 E Calderwood Dr Ste 150D
Meridian, ID 83642-9095
Phone
(208) 402-8946
Fax
(208) 248-6939
NPI assigned
Jul 31, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X NPPEND ID
Nurse Practitioner 363L00000X NP1318A ID Primary

Addresses

Primary practice location

176 E Calderwood Dr Ste 150D
Meridian, ID 83642-9095

Mailing address

2169 W Oakhampton Dr
Eagle, ID 83616-7632
Phone (208) 631-2121

Other identifiers 2

IdentifierTypeStateIssuer
G8937328OtherWAMEDICARE
0338594OtherWAL&I

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
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP1318AIDMDNurse Practitioner
NPPENDIDMDObstetrics & Gynecology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Family Medicine PLLC CurrentSince Apr 17, 2022 Accepting new patients
Kuna Healthcare Clinic, PLLC Nurse Practitioner CurrentSince Apr 17, 2022 Accepting new patients
Sacred Roots Fertility Consulting, PLLC Current Accepting new patients

Locations

943 N Linder Rd
Ste 103
Kuna, ID 83634
Phone (208) 565-0978

520 S Eagle Rd
Ste 3209
Meridian, ID 83642
Phone (208) 345-5250

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1375228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769990400000",
    "number": "1629400734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2169 W OAKHAMPTON DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167632",
            "telephone_number": "208-631-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 E CALDERWOOD DR STE 150D",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836429095",
            "telephone_number": "208-402-8946",
            "fax_number": "208-248-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARMODY",
        "first_name": "BRENNAN",
        "middle_name": "N",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-31",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "ID",
            "license": "NPPEND",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "NP1318A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G8937328",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0338594",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; 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.