Provider Demographics
NPI:1326877762
Name:ADDI
Entity type:Organization
Organization Name:ADDI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RONNAU
Authorized Official - Suffix:
Authorized Official - Credentials:NP, PMHNP
Authorized Official - Phone:208-515-2273
Mailing Address - Street 1:1672 S WOODSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8329
Mailing Address - Country:US
Mailing Address - Phone:208-515-2273
Mailing Address - Fax:
Practice Address - Street 1:1526 W USTICK RD STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7741
Practice Address - Country:US
Practice Address - Phone:208-370-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN ADVANCED PSYCHIATRY , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-01
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty