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Individual

KIMBERLY JEAN THOMAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
2010 DIANE LN, POCATELLO, ID 83201-1908
(208) 241-8630
Mailing address
2010 DIANE LN, POCATELLO, ID 83201-1908
(208) 241-8630

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
74181
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
74181
APRN LICENSE
ID
Enumeration date
09/23/2022
Last updated
09/23/2022
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