Individual
KELSEY SANDOVAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3025 W CHERRY LN STE A, MERIDIAN, ID 83642-8531
(208) 302-6450
(208) 302-6455
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
56457
CA
363A00000X
Physician Assistant
Primary
PA-2375
ID
Other
Enumeration date
03/07/2019
Last updated
11/28/2022
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