Individual
KAILI MICHELLE SMALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12222 W BRIDGER BAY DR, STAR, ID 83669-5081
(208) 391-2773
Mailing address
133 N ROBINSON BLVD, NAMPA, ID 83687-8617
(208) 249-7597
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/11/2020
Last updated
12/11/2020
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