Active NPI
Alicia Jorgensen, FNP-C
- Family Nurse Practitioner
- Ammon, ID
National Provider Identifier
1770262016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 57312
- Practice address
- 3088 E Chasewood Dr
Ammon, ID 83406-4852 - Phone
- (208) 240-1318
- NPI assigned
- Jul 13, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 57312 | ID | Primary |
Addresses
Primary practice location
3088 E Chasewood Dr
Ammon, ID 83406-4852
Mailing address
3088 E Chasewood Dr
Ammon, ID 83406-4852
Phone (208) 240-1318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 24, 2024 through Oct 24, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57312 | ID | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689724800000",
"number": "1770262016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3088 E CHASEWOOD DR",
"city": "AMMON",
"state": "ID",
"postal_code": "834064852",
"telephone_number": "208-240-1318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3088 E CHASEWOOD DR",
"city": "AMMON",
"state": "ID",
"postal_code": "834064852",
"telephone_number": "208-240-1318"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORGENSEN",
"first_name": "ALICIA",
"credential": "FNP-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-07-13",
"last_updated": "2023-07-19",
"certification_date": "2023-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "ID",
"license": "57312",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ammon, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.