Individual
KELLIE WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6140 W CURTISIAN AVE, BOISE, ID 83704-8880
(208) 302-0130
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
57868
ID
Other
Enumeration date
02/27/2018
Last updated
02/27/2018
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