Individual
KENA D LACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
725 FAIR ST, BUHL, ID 83316-6442
(208) 543-8271
(208) 543-8272
Mailing address
794 EASTLAND DR, TWIN FALLS, ID 83301-6856
(208) 734-3312
(208) 734-5036
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-14465
ID
207Q00000X
Family Medicine Physician
MRM-1634
ID
Other
Enumeration date
04/28/2017
Last updated
12/02/2024
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