Kelleen Louise Fakenbridge, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP732 Issued in ID

Practice address

8324 W Northview St
Suite 100
Boise, ID 83704-7184

Phone

(208) 376-8337

Fax

(208) 376-8344

NPI assigned

May 23, 2007

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Gem State Radiology LLP

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1083661508
  NPD (past)
• Idaho Minor Emergency and Family Practice PA

  • Clinic/Center
  • Meridian, ID
  • NPI 1205996063
  NPD (past)
• Jeffrey F Hartford MD

  • Family Medicine Physician
  • Boise, ID
  • NPI 1417151804
  NPD (past)

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340841600000",
    "number": "1710197264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8324 W NORTHVIEW ST",
            "address_2": "SUITE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837047184",
            "telephone_number": "208-376-8337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8324 W NORTHVIEW ST",
            "address_2": "SUITE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837047184",
            "telephone_number": "208-376-8337",
            "fax_number": "208-376-8344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAKENBRIDGE",
        "first_name": "KELLEEN",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2012-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Ann Fairchild, DC
• Penny Michelle Faires, M.D.
• Riley Fairgrieve, LPC
• Bahar Faizi
• Gabriel Fajardo Jr.
• Erick A Falconer, M.D.
• Gary Falk, M.D.
• Kathy Mae Falk, NP & RN
• Jordyn Lynn Falkner
• Michaela Falkner, N.M.D.

• 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 Jun 28, 2012; 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.