Individual
KATHRYN JILL ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1800 FLANDRO DR, STE 110, POCATELLO, ID 83202-4936
(208) 904-1544
(208) 904-1052
Mailing address
1800 FLANDRO DR, STE 110, POCATELLO, ID 83202-4936
(208) 242-3723
(208) 904-1052
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1287A
ID
Other
Enumeration date
07/09/2013
Last updated
08/08/2018
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