Kellie Kathryn Breaux, FNP-MSN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

55031 Issued in ID

Practice address

700 W Ironwood Dr
Suite 155
Coeur D Alene, ID 83814-2656

Phone

(208) 667-0585

Fax

(208) 667-0876

NPI assigned

Jan 27, 2017

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

Enrolled in WA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Interoperability endpoints

• Direct secure messaging: kellie.breaux@nwsh.gwaydirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Idaho Day Surgery LLC

  dba Northwest Specialty Hospital

  • General Acute Care Hospital
  • Post Falls, ID
  • NPI 1104824739
  NPD (past)
• North Idaho Day Surgery LLC

  • Multi-Specialty Clinic/Center
  • Coeur d'Alene, ID
  • NPI 1588588529
  NPD (past)

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

{
    "created_epoch": "1485475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499644800000",
    "number": "1861939910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W. IRONWOOD DRIVE",
            "address_2": "SUITE 155",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "838144462",
            "telephone_number": "208-667-0585",
            "fax_number": "208-667-0876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR",
            "address_2": "SUITE 155",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142656",
            "telephone_number": "208-667-0585",
            "fax_number": "208-667-0876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREAUX",
        "first_name": "KELLIE",
        "middle_name": "KATHRYN",
        "name_prefix": "Mrs.",
        "credential": "FNP-MSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-27",
        "last_updated": "2017-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "55031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael L Brandt, PHARMD
• Michah Brasseur, M.D.
• Jillienne Braucher Sells, DPT
• Bailey Braun, PA-C
• Breath of Life Sleep Medicine PC
• Lisa G Breisacher, L.N.P.
• Jill Efta Breitbach, PSY D
• Brent R. Unruh, DMD, PA
• Brevity Treatment Services
• Bri Health PLLC

• Family Nurse Practitioner in Coeur d'Alene, ID
• Providers in Coeur d'Alene, 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 Jul 10, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.