BRENDA J SHAW (NPI# 1679642037) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679642037 |
| Entity Type | Individual |
| Full Name | BRENDA J SHAW |
| Credential | PA |
| Practice Address |
1660 John Adams Pkwy Idaho Falls ID 83401-4360 |
| Practice Telephone | 2085238844 |
| Practice Fax Number | 2085298684 |
| Mailing Telephone | 2085238844 |
| Mailing Fax Number | 2085298684 |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2009-12-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA587 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 807324700 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003134578 | Brenda Joanne Shaw | Chore Provider | 127 Slow Mill Dr, Goose Creek, SC 29445-9614 | 2010-05-09 |
| Street Address |
1660 JOHN ADAMS PKWY |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83401-4360 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316910797 | Stephanie Morgan | Physician Assistant | 1660 John Adams Pkwy, Idaho Falls, ID 83401-4360 | 2006-02-08 |
| 1265635346 | Life Spring Women's Clinic, P.a. | Nurse Practitioner | 1660 John Adams Pkwy, Idaho Falls, ID 83401-4360 | 2007-06-07 |
| 1992840326 | Life Spring Womens Clinic, P.a. | Obstetrics & Gynecology | 1660 John Adams Pkwy, Idaho Falls, ID 83401-4360 | 2007-02-21 |
| 1790849529 | Verla R. Ottley | Nurse Practitioner | 1660 John Adams Pkwy, Idaho Falls, ID 83401-4360 | 2006-12-19 |
| 1003979352 | Craig Z. Hall | Obstetrics & Gynecology | 1660 John Adams Pkwy, Idaho Falls, ID 83401-4360 | 2006-12-18 |
| 1851470785 | Denise Loraine Barnes | Nurse Practitioner | 1660 John Adams Pkwy, Idaho Falls, ID 83401-4360 | 2006-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454796 | Natalie M Theriault | Acupuncturist | 864 S Holmes, Idaho Falls, ID 83401 | 2020-10-09 |
| 1366099293 | Idaho Recovery Center, LLC. | Counselor | 771 South Woodruff Avenue, Idaho Falls, ID 83401 | 2019-08-26 |
| 1851859110 | Rebecca Chidester | Counselor | 771 Parkwood St., Idaho Falls, ID 83401 | 2019-03-06 |
| 1467924985 | Benchmark Home Health | Registered Nurse | 2098 Gladys Dr., Idaho Falls, ID 83401 | 2018-12-21 |
| 1134625338 | Idaho Falls Hand Therapy Limited Partnership | Clinic/Center | 564 S Woodruff Avenue, Idaho Falls, ID 83401 | 2018-04-05 |
| 1992227367 | Brenda Emery | Rehabilitation Practitioner | 540 3rd Street, Idaho Falls, ID 83401 | 2017-07-07 |
| 1689068454 | Addiction Treatment Centers of Idaho | Community/Behavioral Health | 211 S. Woodruff Avenue, Idaho Falls, ID 83401 | 2015-03-19 |
| 1386986412 | Jennifer Lee Henderson | Psychologist | 111 E. 16th Street, Innovative Health Care Concepts Inc., Idaho Falls, ID 83401 | 2013-03-27 |
| 1487994430 | Sterling Physician Group Pllc | Clinic/Center | 740 S. Woodruff Ave, Idaho Falls, ID 83401 | 2013-02-27 |
| 1952638025 | Allstar Counseling Inc. | Case Management | 550 2nd Street, Suite 269, Idaho Falls, ID 83401 | 2009-11-11 |
| Find all providers in zip 83401 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740646363 | Chad Coon | Physician Assistant | 3405 Merlin Dr, Idaho Falls, ID 83404-7430 | 2016-01-12 |
| 1023489085 | Kelly Meacham | Physician Assistant | 3389 Merlin Dr, Idaho Falls, ID 83404-7405 | 2015-10-15 |
| 1891188348 | Alan Adams | Physician Assistant | 3820 Crestwood Ln, Idaho Falls, ID 83404-4979 | 2015-03-09 |
| 1841460508 | Keri Martin | Physician Assistant | 3360 Washington Parkway, Suite 2, Idaho Falls, ID 83404-2271 | 2008-03-08 |
| 1073676805 | Monica J Nealis | Physician Assistant | 1550 Elk Creek Dr, Idaho Falls, ID 83404-8322 | 2006-12-19 |
| 1639248008 | Lori Ann Woodbury | Physician Assistant | 2327 Coronado St, Idaho Falls, ID 83404-7407 | 2006-11-07 |
| 1093803157 | Tiffany Christiansen | Physician Assistant | 150 Shoup Ave Ste 17, Idaho Falls, ID 83402-3653 | 2006-10-11 |
| 1730190935 | Roger Scott Malm | Physician Assistant | 740 S Woodruff Ave, Idaho Falls, ID 83401-5285 | 2006-08-11 |
| 1316985229 | Matthew J Merzlock | Physician Assistant | 3360 Washington Pkwy Ste 1, Idaho Falls, ID 83404-8333 | 2006-06-03 |
| 1649221912 | Matthew R Nelson | Physician Assistant | 2375 E Sunnyside Rd Ste J, Idaho Falls, ID 83404-8281 | 2006-05-12 |
| Find all providers in IDAHO FALLS | ||||
| City | IDAHO FALLS |
| Zip Code | 83401 |
Please comment or provide details below to improve the information on BRENDA J SHAW.
| 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.