KURT R MAYBERRY (NPI# 1891886479) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891886479 |
| Entity Type | Individual |
| Full Name | KURT R MAYBERRY |
| Credential | MD |
| Practice Address |
450 E Main St Rexburg ID 83440-2048 |
| Mailing Address |
450 E Main St Po Box 310 Rexburg ID 83440-2048 |
| Practice Telephone | 2083563691 |
| Mailing Telephone | 2083563691 |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | M8416 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE SHIELD OF IDAHO # | 000010139001 | 01 |
| ID | BLUE CROSS OF IDAHO # | 028692 | 01 |
| ID | STATE LICENSE # | M8416 | 01 |
| Street Address |
450 E MAIN ST |
| City | REXBURG |
| State | ID |
| Zip Code | 83440-2048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639111206 | Madison Physician Services | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2006-06-11 |
| 1396352142 | Karissa Thueson | Nurse Practitioner | 450 E Main St, Rexburg, ID 83440-2048 | 2020-09-25 |
| 1376192674 | David Howard Anderson | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2019-09-09 |
| 1124676663 | Susan B Clark | Dietitian, Registered | 450 E Main St, Rexburg, ID 83440-2048 | 2019-08-28 |
| 1790278760 | Allen Terry Miller | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2018-06-13 |
| 1831682194 | Dorsie Thomas Sullenger | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2018-06-12 |
| 1184122756 | Steven Craig Pierce | Physician Assistant | 450 E Main St, Rexburg, ID 83440-2048 | 2018-01-29 |
| 1215471065 | Troy Hanson | Nurse Practitioner | 450 E Main St, Rexburg, ID 83440-2048 | 2016-12-13 |
| 1346692605 | University of Utah Pediatric Services | Pediatrics | 450 E Main St, Rexburg, ID 83440-2048 | 2016-07-11 |
| 1871941724 | Justin Shippen | Family Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2016-06-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235768490 | Henry's Fork Surgery Center Pllc | Clinic/Center | 23 Sawtelle Ave, Rexburg, ID 83440 | 2020-04-08 |
| 1952956906 | Shane Ellis Withers | Pharmacist | 164 E. Main, Rexburg, ID 83440 | 2019-08-06 |
| 1316392285 | Emma Anderson | Speech-Language Pathologist | 36 Professional Plaza Suite 110, Rexburg, ID 83440 | 2016-04-28 |
| 1851755524 | Sandra Frickey | Speech-Language Pathologist | 1087 Summers Drive, Premier Therapy Associates, Rexburg, ID 83440 | 2016-04-08 |
| 1275997215 | Kerry Denney | Counselor | 333 Walker Drive, Rexburg, ID 83440 | 2016-04-06 |
| 1467837583 | Wal-mart Stores, Inc. | Technician/Technologist | 303 E Moody Rd, Rexburg, ID 83440 | 2015-07-30 |
| 1649692609 | Tanabell Health Services, Inc. | Skilled Nursing Facility | 410 W 1st N, Rexburg, ID 83440 | 2014-01-10 |
| 1043652571 | Creed Simon Webster | Counselor | 30 S 2nd W, Rexburg, ID 83440 | 2013-07-25 |
| 1033461660 | James Cannon Allen Dds PC | Dentist | 106 E 1st North, Rexburg, ID 83440 | 2012-10-05 |
| 1417217316 | Shelby Dee Woolstenhulme | Speech-Language Pathologist | 450 E. Main Street, Rexburg, ID 83440 | 2012-05-24 |
| Find all providers in zip 83440 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639111206 | Madison Physician Services | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2006-06-11 |
| 1326209537 | Nathan Chad Hancock | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2008-06-19 |
| 1750472379 | Debra Brand | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2006-09-27 |
| 1639104847 | Edwin G Wells | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2006-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780104851 | Cep America, LLC | Emergency Medicine | 4300 E. Flamingo Ave, Nampa, ID 83687-9203 | 2017-06-21 |
| 1740719905 | Courtney Hutchins | Emergency Medicine | 5841 S. Maryland Avenue Mc1052, J-141, Chicago, ID 60637 | 2017-06-09 |
| 1548798879 | Ideal Option, Pllc | Emergency Medicine | 3110 Cleveland Blvd Bldg A, Caldwell, ID 83605-0718 | 2017-05-31 |
| 1720468101 | Devin Douglas Dredge | Emergency Medicine | 1717 Arlington Ave Dept Of, Caldwell, ID 83605 | 2015-06-01 |
| 1972914406 | Jonathan Robert Jerkins | Emergency Medicine | 700 W Ironwood Dr Ste 155, Coeur D Alene, ID 83814-4462 | 2014-05-19 |
| 1457619074 | William P. Martin | Emergency Medicine | 1279 E Regatta St, Boise, ID 83706-6349 | 2012-05-02 |
| 1922365436 | Colby Austin | Emergency Medicine | 2963 E Copper Point Dr Ste 150, Meridian, ID 83642-9056 | 2012-04-20 |
| 1245514454 | Todd Robert Smith | Emergency Medicine | 3835 S Firenze Way, Meridian, ID 83642-1434 | 2011-10-06 |
| 1124306295 | Austin Heath Rasmussen | Emergency Medicine | 637 Pine St, Gooding, ID 83330-1755 | 2011-07-23 |
| 1962799460 | Tyler James Harris | Emergency Medicine | 1510 12th Ave Rd Ste 100, Nampa, ID 83686 | 2011-07-05 |
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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.