Individual
KALIN DANIAL LISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
STUDENT
Contact information
Practice address
8971 W OVERLAND RD, BOISE, ID 83709-1651
(208) 378-4288
(208) 378-4297
Mailing address
227 SUNRISE RIM RD, NAMPA, ID 83686-8325
(208) 912-3307
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9871643
ID
Other
Enumeration date
11/25/2024
Last updated
03/05/2025
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