# KINGHORN HEALTH AND WELLNESS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639772049
- **Authorized official:** MATTHEW S KINGHORN APRN, FNP-C (PRESIDENT)
- **Authorized official phone:** (208) 520-9336

## Contact information

- **Practice address:** 2001 S WOODRUFF AVE STE 20, IDAHO FALLS, ID 83404-6373
- **Practice address phone:** (208) 970-2355
- **Mailing address:** 2001 S WOODRUFF AVE STE 20, IDAHO FALLS, ID 83404-6373
- **Mailing address phone:** (208) 970-2355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/18/2020
- **Last updated:** 03/26/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | APRN-62114 | STATE | ID |