Individual
KELSY REID HACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1072 N LIBERTY ST STE 201, BOISE, ID 83704-8708
(208) 302-2400
(208) 302-2455
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
Primary
PA-2449
ID
Other
Enumeration date
01/25/2023
Last updated
01/28/2025
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