Individual
ERIK KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
265 W PRAIRIE SHOPPING CTR, HAYDEN, ID 83835-9855
(208) 772-7850
Mailing address
PO BOX 38, HAYDEN, ID 83835-0038
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1657A
ID
Other
Enumeration date
06/21/2016
Last updated
06/21/2016
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