Individual
KIRK EMIL PAOLINELLI JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
4783 N SUMMIT WAY, MERIDIAN, ID 83646-5017
(208) 515-2273
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642
(208) 302-5950
(208) 302-5955
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
57230
ID
363LF0000X
Family Nurse Practitioner
95008301
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
57230
ID
Other
Enumeration date
01/24/2018
Last updated
12/13/2024
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