| Meridian Advanced Psychiatry , Llc | |
|
1672 S Woodsage Ave. Meridan ID 83642 | |
| (208) 515-2273 | |
| (208) 515-2274 |
| Full Name | Meridian Advanced Psychiatry , Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1672 S Woodsage Ave., Meridan, Idaho |
| Authorized Official Name and Position | Kevin Hulsey (CEO) |
| Authorized Official Contact | 2087890202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meridian Advanced Psychiatry , Llc 1672 S Woodsage Avenue Suite #120 Meridan ID 83642 Ph: (208) 515-2273 | Meridian Advanced Psychiatry , Llc 1672 S Woodsage Ave. Meridan ID 83642 Ph: (208) 515-2273 |
| NPI Number | 1609412683 |
|---|---|
| Provider Enumeration Date | 11/25/2019 |
| Last Update Date | 05/12/2020 |
| Certification Date | 05/12/2020 |
| Medicare PECOS PAC ID | 8628490711 |
|---|---|
| Medicare Enrollment ID | O20200618000604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609412683 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Brian L Raymond |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043468903 PECOS PAC ID: 3274689690 Enrollment ID: I20090925000252 |
| Provider Name | Esther S Huffine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326477258 PECOS PAC ID: 9234362096 Enrollment ID: I20140430002592 |
| Provider Name | Kyle Joseph Ronnau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326584640 PECOS PAC ID: 9133492986 Enrollment ID: I20170830002027 |
| Provider Name | Brandy D Fitchett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902315021 PECOS PAC ID: 0042578569 Enrollment ID: I20171211001054 |
| Provider Name | Kirk Emil Paolinelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235637240 PECOS PAC ID: 6204197098 Enrollment ID: I20190329001072 |
| Provider Name | Becky J Bole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043621576 PECOS PAC ID: 5294951687 Enrollment ID: I20191121002661 |
| Provider Name | Adam Burch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205213246 PECOS PAC ID: 1355637323 Enrollment ID: I20200707001694 |
| Provider Name | Jarrod Vaughn Crump |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184240194 PECOS PAC ID: 7911323894 Enrollment ID: I20200824000539 |
| Provider Name | Tyson J Flower |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184258311 PECOS PAC ID: 3173940319 Enrollment ID: I20200826002658 |
| Provider Name | Matthew A Fowler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053943688 PECOS PAC ID: 8224442348 Enrollment ID: I20210202000948 |
| Provider Name | Tonya J Jenott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467072660 PECOS PAC ID: 7214344951 Enrollment ID: I20210325001343 |
| Provider Name | Stephanie Frances Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659962611 PECOS PAC ID: 1557763570 Enrollment ID: I20210714001093 |
| Provider Name | Samantha D Blackburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811534613 PECOS PAC ID: 9234536855 Enrollment ID: I20210924001101 |
| Provider Name | Lenard L Malmin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255908489 PECOS PAC ID: 2365849882 Enrollment ID: I20210927002405 |
| Provider Name | Susan M Derivas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851493829 PECOS PAC ID: 2264512011 Enrollment ID: I20211012003126 |
| Provider Name | Mary H Rankin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154072205 PECOS PAC ID: 0941695969 Enrollment ID: I20220309002415 |
| Provider Name | Mckenzie Morcom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417601840 PECOS PAC ID: 4789079617 Enrollment ID: I20220311001093 |
| Provider Name | James Mccoy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790211092 PECOS PAC ID: 4284988460 Enrollment ID: I20220816002627 |
| Provider Name | Megan Lee Brock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083357651 PECOS PAC ID: 7517343155 Enrollment ID: I20221004003723 |
| Provider Name | Shelly Ann Abell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528791969 PECOS PAC ID: 7911373980 Enrollment ID: I20221017000153 |
| Provider Name | Kyanne Lamay Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649991316 PECOS PAC ID: 9739557729 Enrollment ID: I20221123000139 |
| Provider Name | Kjeranne Rummel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376209460 PECOS PAC ID: 1355711490 Enrollment ID: I20230105001412 |
| Provider Name | Samantha Wynn Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164141107 PECOS PAC ID: 1759752165 Enrollment ID: I20230123001960 |
| Provider Name | Allison Zartman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598473464 PECOS PAC ID: 5991176265 Enrollment ID: I20230124002252 |
| Provider Name | Jon Patxi Criswell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881301075 PECOS PAC ID: 3173995677 Enrollment ID: I20230209002041 |
| Provider Name | Shaina Leeann Lonai |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154033637 PECOS PAC ID: 7214301035 Enrollment ID: I20230317002073 |
| Provider Name | Cheryl Kathryn Burris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225669534 PECOS PAC ID: 5597120824 Enrollment ID: I20230420001496 |
| Provider Name | Tony Bastar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992490254 PECOS PAC ID: 7012379324 Enrollment ID: I20230818001241 |
| Provider Name | Bradley Thomas Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114536737 PECOS PAC ID: 0143683136 Enrollment ID: I20230823003175 |
| Provider Name | Elizabeth Ann Nugent |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972386092 PECOS PAC ID: 2961859160 Enrollment ID: I20231109001912 |
| Provider Name | Carmen Marie Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639952476 PECOS PAC ID: 2860842341 Enrollment ID: I20231226000122 |
| Provider Name | Leslie Pardue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326735911 PECOS PAC ID: 6901258433 Enrollment ID: I20240119001807 |
| Provider Name | Rebekah M Svadlenka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063003895 PECOS PAC ID: 9638584717 Enrollment ID: I20240119003445 |
| Provider Name | Jeremiah Robins Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356123657 PECOS PAC ID: 0446695118 Enrollment ID: I20240304003420 |
| Provider Name | Barbara Mcgee Strauss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538925854 PECOS PAC ID: 4789025438 Enrollment ID: I20240512000040 |
| Provider Name | Rebecca Jane Mcgrath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457189326 PECOS PAC ID: 2567900681 Enrollment ID: I20240820001659 |
| Provider Name | Dean Bigelow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245072594 PECOS PAC ID: 6800336991 Enrollment ID: I20240904000384 |
| Provider Name | Daniel Rulon Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790518751 PECOS PAC ID: 2769917061 Enrollment ID: I20241122003668 |
| Provider Name | Kennedy Nikell Friesen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437982329 PECOS PAC ID: 7719401918 Enrollment ID: I20250409002320 |
| Provider Name | Dianne Yvonne Head |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235935222 PECOS PAC ID: 0244754240 Enrollment ID: I20250411001511 |