Kyle Randall Peterman, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

57854 Issued in ID

Practice address

500 W Fort St
Boise, ID 83702-4501

Phone

(208) 422-1000

NPI assigned

Mar 8, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1678233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1639879596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W FORT ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024599",
            "telephone_number": "208-422-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W FORT ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024501",
            "telephone_number": "208-422-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERMAN",
        "first_name": "KYLE",
        "middle_name": "RANDALL",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-08",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "57854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eryka Peskin
• Billylynn Leiuilani Han Pestell, LCSW
• Michael Pestotnik, M.D.
• Rachel Petek
• Kevin R Peterman, LCSW
• Ester Peters, DO
• Heidi S Peters, NP
• Petersen Mental Health PLLC
• Krista I Petersen, FNP-C
• Lucas Cedric Petersen

• Family Nurse Practitioner in Boise, ID
• Providers in Boise, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.