Individual
KELLY KRAUSE-MINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
6565 W EMERALD ST, BOISE, ID 83704-8737
(208) 514-2510
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2022
ID
363A00000X
Physician Assistant
PAT-1634
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639642051
—
ID
Enumeration date
01/08/2019
Last updated
04/08/2026
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