Individual
KELLY CATHERINE WILKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6052 W STATE ST, BOISE, ID 83703-2739
(208) 344-7799
(207) 344-7152
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6522
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-12528
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245522036
—
ID
Enumeration date
05/11/2011
Last updated
08/13/2015
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