Individual
ELISABETH GAYLE KINGHORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
151 N. 4TH AVE STE B, POCATELLO, ID 83201
(208) 269-7147
(208) 416-6522
Mailing address
151 N. 4TH AVE STE B, POCATELLO, ID 83201
(208) 269-7147
(208) 416-6522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PA-693
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA-693
IDAHO LICENSE
ID
Enumeration date
06/11/2008
Last updated
11/10/2020
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