NPIMap

Organization Active NPI

Functional Medicine of North Idaho, PLLC

  • Nurse Practitioner
  • Hayden, ID
National Provider Identifier
1750920401
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
FUNCTIONAL MEDICINE OF NORTH IDAHO, PLLC
Practice address
8382 N Wayne Dr Ste 204
Hayden, ID 83835-6028
Phone
(208) 635-5265
Fax
(208) 635-5218
NPI assigned
Dec 29, 2019
Last updated
Jul 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Authorized official

Name
Jessica Laplante, ARNPNPI 1487999850
Title
Owner
Phone
(208) 635-5265

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Nurse Practitioner 363L00000X Primary

Addresses

Primary practice location

8382 N Wayne Dr Ste 204
Hayden, ID 83835-6028

Mailing address

1399 N Biztown Loop
Hayden, ID 83835-5044
Phone (208) 635-5265

National Provider Directory

National Provider Directory

Locations

9950 N Biztown Loop
Hayden, ID 83835
Phone (208) 635-5265

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1577577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719792000000",
    "number": "1750920401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1399 N BIZTOWN LOOP",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838355044",
            "telephone_number": "208-635-5265",
            "fax_number": "208-635-5218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8382 N WAYNE DR STE 204",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838356028",
            "telephone_number": "208-635-5265",
            "fax_number": "208-635-5218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL MEDICINE OF NORTH IDAHO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-29",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A",
        "authorized_official_last_name": "LAPLANTE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-635-5265",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayden, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.