Provider Demographics
NPI:1568028249
Name:PIRKLE, MARY RACHEL (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RACHEL
Last Name:PIRKLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1550 ELK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8322
Mailing Address - Country:US
Mailing Address - Phone:208-529-5942
Mailing Address - Fax:208-529-5951
Practice Address - Street 1:1550 ELK CREEK DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8322
Practice Address - Country:US
Practice Address - Phone:208-529-5942
Practice Address - Fax:208-529-5951
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM763367A00000X
COC-APN.0001916-C-CNM367A00000X
ID67242367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife