Individual
KELLEY TILLOTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N., BSN
Contact information
Practice address
421 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 234-7954
(208) 236-6328
Mailing address
421 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 234-7954
(208) 236-6328
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
26756
ID
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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