Organization
ROCKY MOUNTAIN WOMENS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLEE JOHNSON CNM (OWNER)
(208) 497-0541
Entity
Organization
Contact information
Practice address
2065 E 17TH ST STE A, IDAHO FALLS, ID 83404-8042
(208) 497-0541
(208) 497-0873
Mailing address
PO BOX 2578, IDAHO FALLS, ID 83403-2578
(208) 497-0541
(208) 497-0873
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Enumeration date
08/04/2020
Last updated
11/02/2020
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