Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Blue Lakes Gastroenterology PLLC

Organization Nurse Practitioner · NPI 1821299553

Blue Lakes Gastroenterology PLLC is a Nurse Practitioner in Twin Falls, Idaho. Registered with an NPI since 2007.

In the registry since
2007
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

775 Pole Line Rd W Ste 203
Twin Falls, ID 83301-5814
Phone: (208) 814-8300
Fax: (208) 733-8970
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X

Record details

NPI number1821299553
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Ward — Physician · (208) 814-8300
NPI enumeratedMay 30, 2007
Last updated in NPPESMarch 9, 2013
Mailing address775 Pole Line Rd W, Suite 203, Twin Falls, ID 83301-5814

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