Individual provider Active NPI

Keri Johnson

  • Family Nurse Practitioner
  • Nampa, ID
National Provider Identifier
1902256019
Registry record updated Jun 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP-53376 Issued in ID
Practice address
207 1St St S
Nampa, ID 83651-3703
Phone
(208) 466-7869
Fax
(208) 466-5359
NPI assigned
Jun 20, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CNP-53376 ID Primary

Addresses

Primary practice location

207 1St St S
Nampa, ID 83651-3703

Mailing address

PO Box 9
Nampa, ID 83653-0009
Phone (208) 466-7869

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240624001420 ID Practitioner - Nurse Practitioner 1850685983 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gary Gregerson MD PAGroup PAC ID 3173838141, 10 clinicians

Practice addresses (Care Compare)

16111 N Brinson St
Suite 110
Nampa, ID 83687-5509
Phone (208) 468-9400

Hospital & facility affiliations

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CNP-53376IDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gary Gregerson, M.D., P.a. CurrentSince May 1, 2024 Accepting new patients
Gary Gregerson MD PA PastSince May 1, 2024 Accepting new patients

Locations

4850 N Rosepoint Way
Ste 100
Boise, ID 83713
Phone (208) 393-2100

4850 N Rosepoint Way
Boise, ID 83713

215 E Hawaii Ave
Ste 220
Nampa, ID 83686

16111 N Brinson St
#110
Nampa, ID 83687
Phone (208) 468-9400

1611 12th Ave Rd
Ste A
Nampa, ID 83686
Phone (208) 468-9400

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1902256019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836530009",
            "telephone_number": "208-466-7869",
            "fax_number": "208-466-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 1ST ST S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513703",
            "telephone_number": "208-466-7869",
            "fax_number": "208-466-5359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KERI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-20",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "CNP-53376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.