Individual
MR. KELLY MEACHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3389 MERLIN DR, IDAHO FALLS, ID 83404-7405
(208) 552-9831
Mailing address
3389 MERLIN DR, IDAHO FALLS, ID 83404-7405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1290
ID
Other
Enumeration date
10/15/2015
Last updated
10/15/2015
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