Individual
KELLY ANNE HEUSINKVELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10583 W LAKE HAZEL RD, BOISE, ID 83709
(208) 302-5950
(208) 302-5955
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642
(208) 302-5950
(208) 302-5955
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1652
ID
Other
Enumeration date
04/12/2018
Last updated
05/01/2019
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