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Individual

KIMBERLY TENOLD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1450 AVIATION DR STE 203, HAILEY, ID 83333-8785
(208) 727-8295
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
102487
NC
363A00000X
Physician Assistant
102487
NC
363AM0700X
Medical Physician Assistant
Primary
PA-2160
ID

Other

Enumeration date
07/20/2006
Last updated
05/11/2023
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