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

Reatta Omoth, FNP-C

Individual provider Family Nurse Practitioner · NPI 1063256584

Reatta Omoth, FNP-C is a Nurse Practitioner in Twin Falls, Idaho. Qualified in 2024, 2 years ago. Practices with St Lukes Clinic LLC, a 310-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Idaho.

Years since qualifying
2
Licensed in
ID
In the registry since
2024
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

2550 Addison Ave E Ste E
Twin Falls, ID 83301-6748
Phone: (208) 814-7780
Fax: (208) 814-7746
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 9861160 (ID)

Record details

NPI number1063256584
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP-C
Sole proprietorNo
NPI enumeratedJune 20, 2024
Last updated in NPPESSeptember 9, 2024
Certification dateSeptember 9, 2024
Mailing address190 E Bannock St, Boise, ID 83712-6241

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice St Lukes Clinic Llc — 310 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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