Individual
RYAN BLAIR KILLPACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-4100
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-4100
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
07/31/2018
Last updated
07/31/2018
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