Jennifer Wicklund, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704278431 Issued in MI

Practice address

4664 N Penngrove Way Ste 100
Meridian, ID 83646-7442

Phone

(208) 898-7467

Fax

(208) 398-2120

NPI assigned

Jul 15, 2021

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 ID, OR2 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

Mountain Pine Dermatology PLLCGroup PAC ID 8729366455, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Luke's Regional Medical Center Hospital, Boise, ID, CCN 130006

Merit-based Incentive Payment System (MIPS)

Final score

81.94 of 100Reported as group

Quality

69.02

Promoting interoperability

100

Improvement activities

40

Cost

70.79

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwicklund@mtnpinederm.emadirect.md

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.

• Mountain Pine Dermatology, PLLC

  • Dermatology Physician
  • Meridian, ID
  • NPI 1659827665

  OR

  Medicare reassignment Care Compare group NPD
• St Lukes Regional Medical Center

  dba St Lukes Meridian Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  NPD (past)

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

• St Lukes Regional Medical Center

  dba Air St Luke's

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  dba St Lukes Meridian Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1871165118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4664 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467442",
            "telephone_number": "208-898-7467",
            "fax_number": "208-398-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4664 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467442",
            "telephone_number": "208-898-7467",
            "fax_number": "208-398-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKLUND",
        "first_name": "JENNIFER",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-15",
        "last_updated": "2024-02-22",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704278431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joel E Whitt, D.M.D.
• Wholesome Chiropractic, PLLC
• Cathie Darlene Wick, LCSW
• Liam Andrew Wickenburg
• Aimee Wicker, PHARM.D.
• Catherine Wickstrum
• Ted Wiedmann, PHARMD
• Lindsay Rose Wienand, RN
• Kailyn Wiersma
• Emily Wiese, PA-C

• Family Nurse Practitioner in Meridian, ID
• Providers in Meridian, 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 Feb 22, 2024; 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.