Individual
BAILEY MACKYNZIE LENON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CST, CSFA
Contact information
Practice address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
(208) 706-5000
Mailing address
2112 W ANATOLE ST, MERIDIAN, ID 83646-3297
(208) 954-9792
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
209885
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209885
NBSTSA
ID
Enumeration date
02/04/2026
Last updated
02/04/2026
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