Tyson Smithersen, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2361278 Issued in ID

Practice address

3200 Channing Way Ste 206
Idaho Falls, ID 83404-7546

Phone

(208) 529-2230

Fax

(208) 561-8061

NPI assigned

Dec 26, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT, ID2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Steele Lake Specialty PLLCGroup PAC ID 1153774567, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Steele Lake Specialty PLLC

  • Surgery Physician
  • Idaho Falls, ID
  • NPI 1215716998
  Medicare reassignment Care Compare group NPD
• Spencer J Hardenbrook MD PC

  • Family Medicine Physician
  • Draper, UT
  • NPI 1073909594
  Medicare reassignment NPD
• Idaho Physician Services Inc.

  • Orthopaedic Surgery Physician
  • Idaho Falls, ID
  • NPI 1902841893
  NPD
• Honestar Wound Care PLLC

  • Family Medicine Physician
  • Richardson, TX
  • NPI 1508470170
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Eastern Idaho Health Services Inc

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1225082209
  Care Compare affiliation

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

{
    "created_epoch": "1640476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1679233134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 CHANNING WAY STE 206",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047546",
            "telephone_number": "208-529-2230",
            "fax_number": "208-561-8061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CHANNING WAY STE 206",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047546",
            "telephone_number": "208-529-2230",
            "fax_number": "208-561-8061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1763 W Lunford Ln",
            "address_purpose": "LOCATION",
            "city": "Riverton",
            "state": "UT",
            "postal_code": "840657451",
            "country_code": "US",
            "telephone_number": "208-680-8408",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 N Thanksgiving Way Ste 220",
            "address_purpose": "LOCATION",
            "city": "Lehi",
            "state": "UT",
            "postal_code": "840435492",
            "country_code": "US",
            "telephone_number": "801-477-6161",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITHERSEN",
        "first_name": "TYSON",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-26",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "10808238-4405",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "2361278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven D Smith, MD
• Tayla Smith
• Taylor Drew Smith, MSPH, PA-C
• Tomi Smith, CNIM
• Smith'S Food and Drug Pharmacy
• Jessica Packer Smoot, PA
• Snake River Community Supported Living
• Snake River Counseling Center LLC
• Snake River Family Chiropractic Health and Wellness Center
• Snake River Hearing and Balance LLC

• Family Nurse Practitioner in Idaho Falls, ID
• Providers in Idaho Falls, 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 Jan 15, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.