Individual
KATHLEEN ANN MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1006 VANDERDASSON RD, EMMETT, ID 83617-8880
(208) 944-1537
(208) 944-6067
Mailing address
1006 VANDERDASSON RD, EMMETT, ID 83617-8880
(208) 944-1537
(208) 944-6067
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN00106768
WA
363LF0000X
Family Nurse Practitioner
Primary
73858
ID
363LF0000X
Family Nurse Practitioner
8636044-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP30008033
WA
Other
Enumeration date
04/08/2008
Last updated
02/20/2024
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