DR. RENEE GAULT


Address: 444 Hospital Way Ste 477, Pocatello, ID 83201-2744
Phone: 2082337832

DR. RENEE GAULT (NPI# 1912489980) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1912489980
Entity Type Individual
Full Name DR. RENEE GAULT
Credential DNP, PMHNP-BC
Practice Address 444 Hospital Way Ste 477
Pocatello
ID 83201-2744
Practice Telephone 2082337832
Practice Fax Number 2082337835
Mailing Telephone 2082337832
Mailing Fax Number 2082337835
Enumeration Date 2018-09-05
Last Update Date 2018-11-21
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
59582 ID Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 444 HOSPITAL WAY STE 477
City POCATELLO
State ID
Zip Code 83201-2744

Providers in the same location

NPI Name Taxonomy Address Enumeration
1114228384 Robert Andrew De Wall Counselor 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2010-11-04
1952917353 Wende Christine Leavitt Physician Assistant 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2020-09-21
1669082665 Maggie Gardner Counselor 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2020-08-04
1225655277 Ashley Brianne Rohrbach Counselor 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2020-06-25
1588219497 Elizabeth Macklin Counselor 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2019-08-07
1285289207 Olivia Theresa Ngadjui Counselor 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2019-08-06
1043783368 Amber Carolynn Malay Case Manager/Care Coordinator 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2019-01-09
1801384847 Vincent Marasco Counselor 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2018-04-25
1750887394 Shawn Grischkowsky Peer Specialist 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2018-04-03
1760980023 Lisa Gay Johnston Peer Specialist 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2018-01-31
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1245857952 Lidia Timofeenko Petersen Nurse Practitioner 775 Wayne Ave, Pocatello, ID 83201-3718 2020-06-29
1699070482 Darrin B. Robertson Nurse Practitioner 161 Jefferson Ave, Pocatello, ID 83201-3921 2011-01-25
1851447585 Kathleen Werner-leap Nurse Practitioner 427 N Arthur Ave Ste B, Pocatello, ID 83204-3006 2007-01-26
1114402450 Earl John Weston Nurse Practitioner 1000 N 8th Ave, Pocatello, ID 83201 2018-10-02
1811369689 Jennie Brumfield Nurse Practitioner 1000 N 8th Ave, Pocatello, ID 83201-5757 2015-10-20
1538576491 Vernon Robert Kubiak Nurse Practitioner 1070 Hiline Rd, Suite 210, Pocatello, ID 83201-2947 2014-07-11

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NPI Name Taxonomy Address Enumeration
1790302594 Dumu Psychiatry LLC Nurse Practitioner 9428 W Fairview Ave, Boise, ID 83704-8101 2020-06-29
1861024689 Jessica Erin Bringman Nurse Practitioner 3624 23rd St, Lewiston, ID 83501-6121 2020-02-10
1528610532 Shawn Warren Nurse Practitioner 755 Lomax St, Idaho Falls, ID 83401-2786 2019-07-10
1760950604 Scott A Watkins Nurse Practitioner 2836 Cougar Ave, Nampa, ID 83687-9107 2018-11-08
1104309657 Brigitta Panther Nurse Practitioner 418 W Reese St, Boise, ID 83706-6233 2018-09-11
1659870178 Mark Mcgrath Nurse Practitioner 1309 Ponderosa Dr Ste 103, Sandpoint, ID 83864-8278 2018-02-10
1467855403 Clint Emmett Nurse Practitioner 875 Perimeter Dr # Ms 3140, Moscow, ID 83844-2006 2014-10-06
1639507551 Jason Martin Nurse Practitioner 13734 S 1st E, Idaho Falls, ID 83404-7852 2013-10-31
1881027241 Colleen R Fleming Nurse Practitioner 2025 W Park Place, Ste B, Coeur D Alene, ID 83814-2785 2013-08-20
1053650010 Kellie Ann Northam Nurse Practitioner 192 West State Street, Eagle, ID 83616 2013-02-11
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Competitor

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City POCATELLO
Zip Code 83201

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Dataset Information

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.

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