MR. RANDY PAUL VAWDREY (NPI# 1376568493) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376568493 |
| Entity Type | Individual |
| Full Name | MR. RANDY PAUL VAWDREY |
| Credential | NP |
| Practice Address |
495 Yellowstone Ave Pocatello ID 83201-4531 |
| Mailing Address |
1743 Delmar Place Pocatello ID 83201 |
| Practice Telephone | 2084787422 |
| Mailing Telephone | 2082388145 |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
NP-659 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
495 YELLOWSTONE AVE |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-4531 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144869348 | Sydney Pia Goings | Nurse Practitioner | 495 Yellowstone Ave, Pocatello, ID 83201-4531 | 2020-01-06 |
| 1972035772 | Mvh Pic LLC | Family Medicine | 495 Yellowstone Ave, Pocatello, ID 83201-4531 | 2017-03-30 |
| 1336572858 | Brelan J Lane | Physical Therapist | 495 Yellowstone Ave, Suite A, Pocatello, ID 83201-4531 | 2013-08-20 |
| 1932449519 | Matthew Colt Andersen | Counselor | 495 Yellowstone Ave, Pocatello, ID 83201-4531 | 2013-02-19 |
| 1437432267 | Advanced Healthcare Solutions, LLC | Non-Pharmacy Dispensing Site | 495 Yellowstone Ave, Pocatello, ID 83201-4531 | 2011-09-28 |
| 1558545624 | Charlynn S. Perkes | Physician Assistant | 495 Yellowstone Ave, Physicians Immediate Care Center, Pocatello, ID 83201 | 2007-12-24 |
| 1841487840 | Nic A Hale | Physician Assistant | 495 Yellowstone Ave, Pocatello, ID 83201-4531 | 2007-10-03 |
| 1578665329 | Corey Layne Rasmussen | Specialist | 495 Yellowstone Ave, Suite A, Pocatello, ID 83201-9487 | 2006-09-02 |
| 1922029412 | Jay Warren Willey | Family Medicine | 495 Yellowstone Ave, Pocatello, ID 83201-4531 | 2006-07-21 |
| 1700803632 | Advanced Healthcare Solutions LLC | Clinic/Center | 495 Yellowstone Ave, Pocatello, ID 83201-4531 | 2006-07-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316034689 | Roberta Lynn Turner | Nurse Practitioner | 500 S. 11th Ave, Suite 303, Pocatello, ID 83201 | 2006-10-06 |
| 1437197647 | John C Porter | Nurse Practitioner | 444 Hospital Way, Suite 801, Pocatello, ID 83201-2745 | 2006-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891308094 | Brandon Paul Kruse | Nurse Practitioner | 3345 S Fork Ave, Nampa, ID 83686-4855 | 2020-08-26 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1558986521 | Lisa Kay Stimpson | Nurse Practitioner | 1605 Poen Rd, Kuna, ID 83634-1743 | 2020-06-15 |
| 1730714049 | Care Medical Housecalls PC | Nurse Practitioner | 2040 E Holgate Ct, Eagle, ID 83616 | 2020-03-06 |
| 1295372308 | Elizabeth Balleweg | Nurse Practitioner | 2306 N 31st St, Boise, ID 83703-5628 | 2019-12-09 |
| 1891264545 | Tina Monique Bossolono-williams | Nurse Practitioner | 1385 Parkview Dr Ste 101, Twin Falls, ID 83301-4084 | 2018-11-23 |
| 1821525452 | Kristin Meshelle Hofmann | Nurse Practitioner | 420 W Main St Ste 206, Boise, ID 83702-7363 | 2017-05-14 |
| 1992237648 | Candice Elaine Adams | Nurse Practitioner | 5108 N Maidstone Way, Boise, ID 83713-1367 | 2017-03-31 |
| 1851832695 | Penny Rea | Nurse Practitioner | 5307 Green Valley Pl, Nampa, ID 83686-5790 | 2017-03-13 |
| 1891176798 | Christine Cooper | Nurse Practitioner | 35 W Idaho St, Weiser, ID 83672 | 2015-06-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.