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

Roberta J. Bostian, AGACNP

Individual provider Acute Care Nurse Practitioner · NPI 1972275501

Roberta J. Bostian, AGACNP is a Nurse Practitioner in Idaho Falls, Idaho. Qualified in 2020, 6 years ago. Practices with Corner Clinic St George LLC, an 8-clinician group and accepts Medicare assignment. Licensed in Idaho and Utah.

Years since qualifying
6
Licensed in
ID, UT
In the registry since
2021
Specialties on file
2

Practice location Address checks out

765 S Utah Ave
Idaho Falls, ID 83402-5093
Phone: (208) 525-2600
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 12751401-4405 (UT)
Acute Care Nurse Practitioner Taxonomy 363LA2100X · Licence 68854 (ID)

Record details

NPI number1972275501
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGACNP
Sole proprietorNo
NPI enumeratedOctober 1, 2021
Last updated in NPPESSeptember 12, 2023
Certification dateSeptember 12, 2023

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Corner Clinic St George Llc — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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