Active NPI
Kathryn Sisterman, DNP
- Gerontology Nurse Practitioner
- Boise, ID
National Provider Identifier
1942485891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 59073
- Practice address
- 1055 N Curtis Rd
Boise, ID 83706-1309 - Phone
- (208) 367-2121
- NPI assigned
- Jan 9, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 643423 | CA | |
| Registered Nurse | 163W00000X | 161452 | AZ | |
| Registered Nurse | 163W00000X | 4704244332 | MI | |
| Acute Care Nurse Practitioner | 363LA2100X | 7710 | AZ | |
| Family Nurse Practitioner | 363LF0000X | 17433 | CA | |
| Family Nurse Practitioner | 363LF0000X | 3577 | AZ | |
| Gerontology Nurse Practitioner | 363LG0600X | 59073 | ID | Primary |
Addresses
Primary practice location
1055 N Curtis Rd
Boise, ID 83706-1309
Mailing address
3340 E Goldstone Way
Meridian, ID 83642
Phone (208) 367-4096
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17433 | CA | MD | Clinical Social Worker |
| 161452 | AZ | MD | Registered Nurse |
| 643423 | CA | MD | Registered Nurse |
| 4704244332 | MI | MD | Registered Nurse |
| 7710 | AZ | MD | Acute Care Nurse Practitioner |
| 59073 | ID | MD | Gerontology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534982400000",
"number": "1942485891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 E GOLDSTONE WAY",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "83642",
"telephone_number": "208-367-4096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 N CURTIS RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837061309",
"telephone_number": "208-367-2121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SISTERMAN",
"first_name": "KATHRYN",
"credential": "DNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-09",
"last_updated": "2018-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "643423",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "AZ",
"license": "161452",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704244332",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "AZ",
"license": "7710",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "17433",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AZ",
"license": "3577",
"primary": false
},
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "ID",
"license": "59073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.