Individual
MS. KATHLEEN LEIGH FOSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1075 N CURTIS ROAD, STE 300, BOISE, ID 83706-1309
(208) 367-3330
(208) 367-3331
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-3330
(208) 367-3331
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1165
ID
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
PA-1165
ID
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
PA-1165
ID
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
01/18/2011
Last updated
10/28/2021
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