Provider Demographics
NPI:1134585763
Name:PADILLA, JEANNA (CPNP-PC)
Entity type:Individual
Prefix:MS
First Name:JEANNA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:JEANNA
Other - Middle Name:
Other - Last Name:BERRYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1593 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5326
Mailing Address - Country:US
Mailing Address - Phone:208-262-2300
Mailing Address - Fax:208-262-2390
Practice Address - Street 1:7600 N MINERAL DR STE 600
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9169
Practice Address - Country:US
Practice Address - Phone:208-619-8250
Practice Address - Fax:208-981-9201
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID61048363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics