Individual
KENON KILDEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2402 W. JEFFERSON ST., BOISE, ID 83702
(208) 369-4590
(208) 906-2346
Mailing address
2402 W. JEFFERSON ST., BOISE, ID 83702
(208) 369-4590
(208) 906-2346
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1237A
ID
363LF0000X
Family Nurse Practitioner
RN284255
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002002503
MEDICARE
—
05
—
KK86131
—
RI
Enumeration date
07/29/2009
Last updated
08/07/2019
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