Individual
MICHELLE L KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6140 W CURTISIAN AVE, STE 200, BOISE, ID 83704
(208) 302-0000
(208) 302-0055
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642
(208) 302-0000
(208) 302-0055
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
57400
ID
363L00000X
Nurse Practitioner
A004645
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A004645
STATE LICENSE
AR
Enumeration date
02/05/2016
Last updated
05/16/2018
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