Individual
JOHN THOMAS KEZELE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
44 N 100 E, PRESTON, ID 83263-1326
(208) 852-0137
Mailing address
104 N BEAR RIVER BLFS, PRESTON, ID 83263-5184
(208) 852-2019
(208) 852-7173
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-366A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015341
—
ID
Enumeration date
08/05/2007
Last updated
05/12/2015
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