Kaitlin Cooley, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

58738 Issued in ID

Practice address

4740 N Penngrove Way Ste 100
Meridian, ID 83646-7446

Phone

(208) 938-3663

Fax

(208) 938-3664

NPI assigned

Dec 5, 2021

Last updated

Aug 17, 2022By the provider in NPPES

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 1, 2023 through Aug 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Functional Medicine of Idaho PC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1336656040
  NPD (past)
• Saint Alphonsus Regional Medical Center Inc

  • Psychiatric Hospital Unit
  • Boise, ID
  • NPI 1770687857
  NPD (past)

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

{
    "created_epoch": "1638662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660694400000",
    "number": "1962160192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467446",
            "telephone_number": "208-938-3663",
            "fax_number": "208-938-3664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467446",
            "telephone_number": "208-938-3663",
            "fax_number": "208-938-3664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLEY",
        "first_name": "KAITLIN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-05",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "58738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Elizabeth Cook, M.A., CCC-SLP
• Hannah Frayne Emanuel Cook, RN
• Jennifer Kaye Cook, APRN
• Jessa Cook, ATL, ATC
• Charles Robert Cooley, DMD
• Weslie Cooley, CPNP-PC
• Christine Cooper
• Cypress April Cooper, NP
• Trace Cooper, DO STUDENT
• Dyana Marie Coose

• Nurse Practitioner in Meridian, ID
• Providers in Meridian, ID by specialty
• Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.