Individual
KELLI M PEASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
500 W FORT ST, # 111, BOISE, ID 83702
(208) 422-1326
Mailing address
500 W FORT ST, # 111, BOISE, ID 83702
(208) 422-1326
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/05/2013
Last updated
07/11/2022
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