1316034689 NPI number — ROBERTA LYNN TURNER FNP

Table of content: ABRAHAM MATHEWS (NPI 1336642610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316034689 NPI number — ROBERTA LYNN TURNER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TURNER
Provider First Name:
ROBERTA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HORTON
Provider Other First Name:
ROBERTA
Provider Other Middle Name:
TURNER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316034689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 S. 11TH AVE
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-239-3815
Provider Business Mailing Address Fax Number:
208-239-3814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 S. 11TH AVE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-239-3815
Provider Business Practice Location Address Fax Number:
208-239-3814
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  NP463A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000010159283 . This is a "BLUE SHIELD-DOWNEY" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010159380 . This is a "BLUE SHIELD-AM FALLS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: NPYF4 . This is a "BLUE CROSS-POCATELLO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: NPYF6 . This is a "BLUE CROSS-DOWNEY" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010159285 . This is a "BLUE SHIELD-POCATELLO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010159381 . This is a "BLUE SHIELD-ABERDEEN" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: NPYF3 . This is a "BLUE CROSS-ABERDEEN" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 807618400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPYJ2 . This is a "BLUE CROSS-MCCAMMON" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: P00434966 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010159282 . This is a "BLUE SHIELD-LAVA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1316034689 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPYF2 . This is a "BLUE CROSS-LAVA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: NPYF5 . This is a "BLUE CROSS-AM FALLS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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