Individual
DR. L. MARK KIMSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
305 E LOGAN ST, CALDWELL, ID 83605-4863
(208) 459-2840
(208) 459-3012
Mailing address
305 E LOGAN ST, CALDWELL, ID 83605-4863
(208) 459-2840
(208) 459-3012
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M5654
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010004477
BLUE SHIELD
ID
05
—
000390401
—
CA
01
—
5654-9
BLUE CROSS
ID
Enumeration date
04/13/2006
Last updated
02/06/2024
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