Individual
KAITLIN L COX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
777 HOSPITAL WAY STE 300, POCATELLO, ID 83201-5176
(208) 232-6100
(208) 239-3403
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 232-6100
(208) 785-8529
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1683
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA-1683
ID LICENSE
ID
01
—
PA6337
MA LICENSE
MA
Enumeration date
12/14/2017
Last updated
04/25/2019
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