Crissie Lynne Bacon, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP-1474A Issued in ID

Practice address

312 3Rd St S
Nampa, ID 83651-3717

Phone

(208) 465-7121

NPI assigned

Aug 15, 2014

Last updated

Aug 15, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Christina Lynne Bacon Other name

Medicare fee-for-service enrollment

Enrolled in ID

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

State licenses

Practice roles

Locations

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.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058
  Medicare reassignment
• St Lukes Clinic-Treasure Valley LLC

  dba St Lukes RHC - Trinity Mountain

  • Family Medicine Physician
  • Mountain Home, ID
  • NPI 1417297821
  NPD
• St Lukes Regional Medical Center

  dba St Lukes Meridian Medical Center

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

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

{
    "created_epoch": "1408060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408060800000",
    "number": "1871992776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 3RD ST S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513717",
            "telephone_number": "208-465-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 3RD ST S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513717",
            "telephone_number": "208-465-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "CRISSIE",
        "middle_name": "LYNNE",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-15",
        "last_updated": "2014-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-1474A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINA",
            "last_name": "BACON",
            "middle_name": "LYNNE",
            "prefix": "MS.",
            "credential": "FNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mercedes Nicole Avey, RN
• Awp Dental Group PC (Modern Smiles Nampa)
• Rebecca Rose Axtell
• Marisa Ariel Ayala, LPC
• Jennifer Babcock
• Madison Bacon
• Donald L Bader, OD
• Jessica Louise Baecker, LPC
• Chelsea Chantel Bagby, PHARMD
• Keith Bailey

• Family Nurse Practitioner in Nampa, ID
• Providers in Nampa, 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 Aug 15, 2014; 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.