Individual
KELLEE J CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1032 S BRIDGWAY PL, SUITE 100, EAGLE, ID 83616
(208) 246-0123
(208) 246-0125
Mailing address
1032 S BRIDGE WAY PL, SUITE 100, EAGLE, ID 83616-6099
(208) 246-0123
(208) 246-0125
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC636
ID
Other
Enumeration date
02/07/2007
Last updated
07/08/2007
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