Individual
KADE READY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
85 S MIDDLETON RD, NAMPA, ID 83651-1526
(208) 505-2800
(208) 505-2801
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3661573
ID
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
07/31/2024
Last updated
11/04/2024
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