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NPI Code Detail

MEDICARE: MR. BENJAMIN R KADAS APN

MEDICARE: MR. BENJAMIN R KADAS APN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner58348WY
2363L00000XNurse Practitioner12853375-4405UT
3363LP0808XPsychiatric/Mental Health Nurse Practitioner12853376-4405UT
4363LP0808XPsychiatric/Mental Health Nurse Practitioner3571695ID

General Provider Information

NPI Number : 1912975186
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BENJAMIN R KADAS APN
Provider Business Mailing Address
First Line : 500 S 11TH AVE STE 400
Second Line :
City : POCATELLO
State : ID
Zip : 83201-4880
Country : US
Telephone Number : 208-232-7862
Fax Number : 833-448-2959
Provider Business Practice Location Address
First Line : 517 W 100 N STE 110
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-9826
Country : US
Telephone Number : 435-755-6075
Fax Number : 833-448-2959
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 03/13/2026

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