Individual
TARA KENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3080 E GENTRY WAY STE 210, MERIDIAN, ID 83642-3013
(208) 810-2309
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M-14731
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2016
Last updated
06/20/2019
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