Organization
KINGHORN HEALTH AND WELLNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW S KINGHORN APRN, FNP-C (PRESIDENT)
(208) 520-9336
Entity
Organization
Contact information
Practice address
2001 S WOODRUFF AVE STE 20, IDAHO FALLS, ID 83404-6373
(208) 970-2355
Mailing address
2001 S WOODRUFF AVE STE 20, IDAHO FALLS, ID 83404-6373
(208) 970-2355
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN-62114
STATE
ID
Enumeration date
11/18/2020
Last updated
03/26/2021
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