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Individual

MS. KATHLEEN A. MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
520 S EAGLE RD, SUITE 3209, MERIDIAN, ID 83642-6351
(208) 884-3980
(208) 884-3979
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222

Taxonomy

Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
NP88A
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010016728
REGENCE BLUE SHIELD OF ID
ID
01
000010016729
REGENCE BLUE SHIELD OF ID
ID
01
500029223
RAILROAD MEDICARE
ID
01
781786
DESERET
ID
05
805800900
ID
01
820367722A010
TRICARE
ID
01
820367722C012
TRICARE
ID
01
NPNB1
BLUE CROSS OF IDAHO
ID
Enumeration date
07/19/2006
Last updated
11/10/2012
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