Individual
MAKENA LORYN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9951 W ST LUKES DR, NAMPA, ID 83687-7914
(208) 467-6700
(208) 463-6044
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8866
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/01/2021
Last updated
07/14/2026
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