Individual
KEDRON F.J. BURNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
211 16TH AVE N, NAMPA, ID 83687-4058
(208) 467-4431
(208) 467-7684
Mailing address
US DEPT OF STATE, M/MED/QI, SA-1, WASHINGTON, DC 20522-0001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
527
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA-527
IDAHO MEDICAL LICENSE
ID
Enumeration date
03/06/2007
Last updated
03/07/2023
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