Individual
BRENT D. KOOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3015 E MAGIC VIEW DR, MERIDIAN, ID 83642
(208) 482-5550
(208) 482-5555
Mailing address
3015 E MAGIC VIEW DR, MERIDIAN, ID 83642
(208) 482-5550
(208) 482-5555
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-2774
ID
363AM0700X
Medical Physician Assistant
PA10004744
WA
363AS0400X
Surgical Physician Assistant
PA-2774
ID
363AS0400X
Surgical Physician Assistant
PA10004744
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8418030
—
WA
Enumeration date
01/17/2007
Last updated
04/22/2026
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