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WALKING E FAMILY PRACTICE, PLLC

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Company Details

Name: WALKING E FAMILY PRACTICE, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 20 Mar 2021 (4 years ago)
Financial Date End: 31 Mar 2026
Entity Number: 4214769
Place of Formation: IDAHO
File Number: 753945
ZIP code: 83338
County: Jerome County
Principal Address: 48 W 600 S JEROME, ID 83338
Mailing Address: 48 W 600 S JEROME, ID 83338-6009

Agent

Name Role Address
STACIE BENKULA Agent 48 W 600 S, JEROME, ID 83338

Member

Name Role Address Appointed On
STACIE BENKULA Member 48 W 600 S, JEROME, ID 83338 2022-04-09

National Provider Identifier

NPI Number:
1710738968
Certification Date:
2024-07-03

Authorized Person:

Name:
JOANN HABBABA
Role:
PATIENT SERVICES COORDINATOR
Phone:

Taxonomy:

Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
2082139822

Filing

Filing Name Filing Number Filing date
Annual Report 0006197134 2025-04-06
Annual Report 0005588950 2024-02-06
Annual Report 0005191995 2023-04-08
Annual Report 0004693351 2022-04-09
Annual Report 0004693350 2022-04-09

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Date of last update: 19 May 2025

Sources: Idaho Secretary of State