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Individual

KAY M POWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
9 AIRPORT RD, BLACKFOOT, ID 83221-1702
(208) 782-3979
(208) 782-3994
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 782-3700
(208) 782-3994

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-343A
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010153632
REGENCE BLUE SHIELD
ID
01
270387
ALTIUS OLD
ID
01
313074
ALTIUS
ID
01
NPX02
BLUE CROSS OLD
ID
01
NPYU4
BLUE CROSS
ID
Enumeration date
05/03/2006
Last updated
04/17/2008
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