NPI age
9 years
Enumerated 2016-09-12
● Active Type 2 · Organization
Family Practice By The Lake Llc
Family Practice By The Lake Llc is 1 of 1691 family medicine organizations in Idaho.
Primary specialty
Family Medicine
Plus 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Wagner
Owner
Last NPPES update
2024-03-25
Source: monthly bulk 2026-05
How this organization compares
Across 1691 active family medicine providers in Idaho.
NPI age
9 years
↓ 8 yr below median
Practice locations
1
0 secondary on file
Subspecialties
1
In the 31% of peers with subspecialties
NPI lifetime · 2016 → 2026
2016-09Enumerated in NPPES
2016
2026
Where they practice
Primary practice location
1875 N Lakewood Dr Ste 205
Coeur D Alene, ID 838144928
Mailing address
1875 N Lakewood Dr Ste 205
Coeur D Alene, ID 838144928
Authorized official
Jacqueline Lee Wagner, FNP
Owner
📞 2086611181
Individual providers at this organization
1 individual provider on file at this primary practice address.
- Jada Rickheim, ARNP Nurse Practitioner NPI 1184338469
Specialties
-
Family Medicine PrimaryFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of...
-
Nurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum...
Practice context
Multi-provider organization. 1 individual provider on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.