NPI age
9 years
Enumerated 2016-08-30
● Active Type 2 · Organization
Mountain Pine Dermatology, Pllc
Mountain Pine Dermatology, Pllc is 1 of 102 dermatology organizations in Idaho.
Primary specialty
Dermatology
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Thomas
Owner
Last NPPES update
2020-07-05
Source: monthly bulk 2026-05
How this organization compares
Across 102 active dermatology providers in Idaho.
NPI age
9 years
↓ 9 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2016 → 2026
2016-08Enumerated in NPPES
2016
2026
Where they practice
Primary practice location
4664 N Penngrove Way Ste 100
Meridian, ID 836467442
Mailing address
4664 N Penngrove Way Ste 100
Meridian, ID 836467442
Authorized official
Richard Scott Thomas, D.O.
Owner
📞 2082507433
Individual providers at this organization
7 individual providers on file at this primary practice address.
- Ladessa Christensen, NP-C Nurse Practitioner NPI 1215367685
- Avery Dinallo, DNP, APN, FNP-C Nurse Practitioner NPI 1902328404
- Vienna Katana, DO Dermatology NPI 1871832881
- Chelsea Miller, PA-C Physician Assistant NPI 1043659196
- Benjamin Perry, D.O. Dermatology NPI 1710325758
- Richard Thomas, D.O. Dermatology NPI 1265795660
- Jennifer Wicklund, FNP-C Nurse Practitioner NPI 1871165118
Specialties
-
Dermatology PrimaryA dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The...
Practice context
Multi-provider organization. 7 individual providers on file at this primary address.
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Request a quote →How to verify this organization
- 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.