Provider Demographics
NPI:1992327738
Name:BIRKEL, JAMESEN (MSN, APRN)
Entity type:Individual
Prefix:MR
First Name:JAMESEN
Middle Name:
Last Name:BIRKEL
Suffix:
Gender:M
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S WOODRUFF AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6371
Mailing Address - Country:US
Mailing Address - Phone:208-419-3002
Mailing Address - Fax:208-656-5652
Practice Address - Street 1:2001 S WOODRUFF AVE STE 9
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6371
Practice Address - Country:US
Practice Address - Phone:208-419-3002
Practice Address - Fax:208-656-5652
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS146643163W00000X
KS5379777022363LP0808X
ID71968363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse