JILL MOUGHAMIAN (NPI# 1760845259) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760845259 |
| Entity Type | Individual |
| Full Name | JILL MOUGHAMIAN |
| Credential | NP |
| Practice Address |
4700 N Cloverdale Rd Ste 103 Boise ID 83713-1067 |
| Mailing Address |
2965 E Tarpon Dr Ste 150 Meridian ID 83642-9007 |
| Practice Telephone | 2083928383 |
| Mailing Telephone | 2082879420 |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2016-04-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
NP-1708A | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | STATE LICENSE | NP-1708A | 01 |
| Street Address |
4700 N CLOVERDALE RD STE 103 |
| City | BOISE |
| State | ID |
| Zip Code | 83713-1067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285658302 | Blake Louis Howard | Chiropractor | 4700 N Cloverdale Rd Ste 103, Boise, ID 83713-1067 | 2006-07-26 |
| 1952815623 | Live Well Health and Nutrition Pllc | Clinic/Center | 4700 N Cloverdale Rd Ste 103, Boise, ID 83713-1067 | 2017-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
| 1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
| 1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
| 1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
| 1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
| 1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
| Find all providers in zip 83713 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356959100 | Taylor Frances Mello | Nurse Practitioner | 2770 N Woodview Pl, Boise, ID 83702-6541 | 2020-07-17 |
| 1275192205 | Luna Hodges | Nurse Practitioner | 125 E Idaho St Ste 200, Boise, ID 83712-6225 | 2019-06-12 |
| 1073675617 | Leona Jo'anne' Church | Nurse Practitioner | 1655 W Fairview Ave Ste 206, Boise, ID 83702-5190 | 2006-12-13 |
| 1386204758 | Aimee Lynn Hastriter | Nurse Practitioner | 125 E Idaho St Ste 200, Boise, ID 83712-6225 | 2019-06-18 |
| 1659844066 | Rachel Bentley | Nurse Practitioner | 1072 N Liberty St Ste 200, Boise, ID 83704-8963 | 2019-01-08 |
| 1326388653 | Mitzi M Cieslak | Nurse Practitioner | 100 E Idaho St, Ste 200, Boise, ID 83712-6267 | 2013-02-23 |
| 1083977391 | Dawn L Powell | Nurse Practitioner | 610 W Hays St, Boise, ID 83702-5511 | 2012-06-21 |
| 1437467644 | Jaeger A Ashton | Nurse Practitioner | 305 E Jefferson St, Boise, ID 83712-6273 | 2010-09-22 |
| 1619158144 | Margaret A Henbest | Nurse Practitioner | 190 E Bannock St, Boise, ID 83712-6241 | 2007-11-27 |
| 1811184492 | Alisa D. Ortega | Nurse Practitioner | 417 S 6th St, Boise, ID 83702-7632 | 2007-09-27 |
| Find all providers in BOISE | ||||
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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.