Individual
KELLY JO VINCENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8854 W EMERALD ST, SUITE #102, BOISE, ID 83704-4844
(208) 323-4747
(208) 323-4848
Mailing address
1940 S BONITO WAY STE 190, MERIDIAN, ID 83642-5618
(208) 287-9420
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1332
ID
Other
Enumeration date
12/09/2015
Last updated
04/19/2023
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