Organization
ROTH FAMILY MEDICINE AND MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE ABRAHAM ROTH FNP (AUTHORIZED OFFICIAL)
(208) 423-8132
Entity
Organization
Contact information
Practice address
444 HOSPITAL WAY STE 422, POCATELLO, ID 83201-2744
(208) 423-8132
(208) 203-6420
Mailing address
444 HOSPITAL WAY STE 422, POCATELLO, ID 83201-2744
(208) 423-8132
(208) 203-6420
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
363L00000X
Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
03/24/2026
Last updated
06/11/2026
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