Individual
BRITAINY KINGSMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6051 W EMERALD ST, BOISE, ID 83704-8969
(208) 302-5150
(208) 302-5155
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 302-9342
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2361576
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
ID
Other
Enumeration date
06/21/2022
Last updated
10/17/2024
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