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LAKESIDE MEDICINE AND AESTHETICS LLC
NPI 1851873756
Nurse Practitioner - Primary Care in Sandpoint, ID

Active since September 06, 2018CLIA 13D2156095 · Waiver
1005 HIGHWAY 2, SANDPOINT, ID 83864(208) 290-3302 Get Directions Write a Review

NPPES record last updated: March 6, 2019. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Mar 6, 2019, Feb 28, 2019, Sep 6, 2018 (3 updates tracked since 2018).

About Lakeside Medicine And Aesthetics Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKESIDE MEDICINE AND AESTHETICS LLC (NPI 1851873756) is a healthcare organization registered as a primary care in Sandpoint, Idaho and active in the NPI registry since September 2018. The organization holds a CLIA Waiver certificate valid through October 9, 2026 and lists Kelly Fuhrman, Owner/np, as its authorized official.

NPPES Registry Identity

NPI1851873756
Entity TypeOrganization
Primary Taxonomy363LP2300X
Legal Business NameLAKESIDE AESTHETICS - LLC
Location Address1005 HIGHWAY 2Sandpoint, ID 83864-1702
Mailing AddressPo Box 333Sagle, ID 83860-0333 · (208) 290-3302
Phone(208) 290-3302
Organization SubpartNo
Authorized OfficialKelly FuhrmanOwner/np · (208) 290-3302
Enumeration DateSeptember 6, 2018
Last NPPES UpdateMarch 6, 20193 updates tracked since enumeration
✔ NPI 1851873756 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
License✔ Licensed in ID · NP1029A
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedNurse PractitionerTaxonomy 363L00000X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
1005 HIGHWAY 2, Sandpoint, ID 83864
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Other Names 1

Doing Business AsLakeside Medicine And Aesthetics Llc

Other Identifiers 1

OtherNP1029AID · Idaho State License Number

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2156095

Lakeside Medicine · Sandpoint, ID
Active · expires Oct 9, 2026
CLIA Number13D2156095
Laboratory TypePractitioner Other
Certificate Effective DateOctober 10, 2024
Certificate Expiration DateOctober 9, 2026
Laboratory DirectorKelly A. Fuhrman Bc-Arnp
Laboratory Phone(208) 290-3302
Laboratory LocationLakeside Medicine1005 Highway 2 West, Sandpoint, ID 83864
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ERICKSON PT ENTERPRISES PLLC
Physical Therapist
1005 HIGHWAY 2
SANDPOINT, ID 83864
Bonner County (208) 263-1632
JOHN MCLAIN FAGGARD III M.D.
Specialist
1005 HIGHWAY 2
SANDPOINT, ID 83864
Bonner County (208) 265-5916
SHAWNA ELISA BENNER-ERICKSON MPT
Physical Therapist
1005 HIGHWAY 2
SANDPOINT, ID 83864
Bonner County (208) 263-1632
MRS. KELLY A. FUHRMAN ARNP FNP-BC
Nurse Practitioner (Family)
1005 HIGHWAY 2
SANDPOINT, ID 83864
Bonner County (208) 290-3302

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lakeside Aesthetics - LLC's NPI number?

The NPI number for Lakeside Aesthetics - LLC is 1851873756. It was assigned to this organization in the NPPES registry on September 6, 2018. The provider is doing business as Lakeside Medicine And Aesthetics LLC.

Where is Lakeside Aesthetics - LLC located?

Lakeside Aesthetics - LLC is located at 1005 Highway 2, Sandpoint, ID 83864. The listed phone number is (208) 290-3302.

What is Lakeside Aesthetics - LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Does Lakeside Aesthetics - LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2156095) is associated with this NPI, valid through October 9, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lakeside Aesthetics - LLC was last updated on March 6, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.