Individual
MCKAYLA ANN LIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
775 POLE LINE RD W STE 203, TWIN FALLS, ID 83301-5820
(208) 814-8300
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9861073
ID
Other
Enumeration date
10/31/2024
Last updated
01/07/2025
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