Individual
MS. KELLEY WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
445 N JOHNSON AVE, POCATELLO, ID 83204-3021
(208) 251-3528
Mailing address
445 N JOHNSON AVE, POCATELLO, ID 83204-3021
(208) 251-3528
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
Other
Enumeration date
05/11/2016
Last updated
05/13/2016
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