Organization
ROTH FAMILY MEDICINE AND MENTAL HEALTH
Active
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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