Organization
ROTH FAMILY MEDICINE AND MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE ABRAHAM ROTH FNP (NURSE PRACTITIONER)
(510) 502-9455
Entity
Organization
Contact information
Practice address
2890 RIDGEVIEW LN, POCATELLO, ID 83204-7291
(510) 502-9455
Mailing address
2890 RIDGEVIEW LN, POCATELLO, ID 83204-7291
(510) 502-9455
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/21/2026
Last updated
03/21/2026
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