Individual
KATHY GAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
30410 HIGHWAY 200, PONDERAY, ID 83852-9601
(208) 263-1345
(208) 255-5531
Mailing address
30410 HIGHWAY 200, PONDERAY, ID 83852-9601
(208) 263-1345
(208) 255-5531
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-257A
ID
Other
Enumeration date
07/30/2006
Last updated
12/13/2007
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