Individual
JACQUELINE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
500 W FORT ST # 111, BOISE VAMC, BOISE, ID 83702-4501
(208) 422-1314
Mailing address
500 W FORT ST # 111, BOISE VAMC, BOISE, ID 83702-4501
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MRM-1350
ID
Other
Enumeration date
03/27/2013
Last updated
12/21/2021
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