Individual
KYLE HOLLENBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2280 AMERICAN LEGION BLVD, MOUNTAIN HOME, ID 83647-3142
(208) 587-3988
(208) 587-3324
Mailing address
486 W 1ST AVE, GLENNS FERRY, ID 83623-2701
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1330
ID
Other
Enumeration date
12/10/2015
Last updated
02/19/2020
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