Individual
KATHLEEN ROSE NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2640 S EAGLE RD, MERIDIAN, ID 83642-6704
(208) 884-0835
(208) 884-4794
Mailing address
2640 S EAGLE RD, MERIDIAN, ID 83642-6704
(208) 884-0835
(208) 884-4794
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA411
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA411
IDAHO MEDICAL LICENSE
ID
Enumeration date
05/30/2006
Last updated
06/02/2026
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