Individual
KEVIN SCOTT SHEARING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2094
(208) 381-1791
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2094
(208) 381-1791
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1217
ID
Other
Enumeration date
12/15/2014
Last updated
12/15/2014
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