William Jack Ashline, NNP
Individual provider Active NPI Neonatal Nurse Practitioner · Boise, ID
NPI 1669162137 · NPPES record last updated Jan 24, 2024
Key facts
- NPI
- 1669162137
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neonatal Nurse Practitioner 363LN0000X
- License
- 53654 (ID)
- Practice address
- 190 E Bannock St
Boise, ID 83712-6241 - Phone
- (208) 381-2222
- NPI assigned
- May 9, 2023
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250520001609 | ID | Practitioner - Nurse Practitioner | 2860910114 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104775275 | ID | MD | Neonatal Nurse Practitioner |
| 53654 | ID | MD | Neonatal Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Clinic-Treasure Valley LLC | Current |
Accepting new patients | |
| St Lukes Clinic-Treasure Valley LLC | Current |
Accepting new patients | |
| St Lukes Regional Medical Center | Past | Accepting new patients |
Locations
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
610 W Hays St
Boise, ID 83702
Phone (208) 345-3530
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal Intensive Care Registered Nurse | 163WN0002X | 53654 | ID | |
| Neonatal Nurse Practitioner | 363LN0000X | 104775275 | ID | |
| Neonatal Nurse Practitioner | 363LN0000X | 53654 | ID | Yes |
Addresses
Primary practice location
190 E Bannock St
Boise, ID 83712-6241
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2222
Other providers in Boise, ID
- Ashley Manor, LLC
- Ashley Manor, LLC
- Ashley Manor, LLC
- Ashley Manor, LLC
- Megan Ashline
- Constance Ashmore
- Jaeger A Ashton
- Ashwood Recovery LLC
- Ashwood Recovery LLC
- Mina Askaryar
All providers in Boise, ID · Neonatal Nurse Practitioner in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.