MEDICARE: KILEY ALYSE ZEITLER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	54013	ID

General Provider Information

NPI Number	:	1528710613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KILEY ALYSE ZEITLER NP

Provider Business Mailing Address
First Line	:	7322 BARON LN
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83714-5094
Country	:	US
Telephone Number	:	925-518-1403
Fax Number	:

Provider Business Practice Location Address
First Line	:	6965 N GLENWOOD ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83714-1967
Country	:	US
Telephone Number	:	208-853-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2022
Last Update Date	:	03/14/2022

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