Healthcare Provider Details

I. General information

NPI: 1366560971
Provider Name (Legal Business Name): JUST 4 KIDS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3067 EAGLE DR
AMMON ID
83406-1273
US

IV. Provider business mailing address

3067 EAGLE DR
AMMON ID
83406-1273
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-4600
  • Fax: 208-552-7521
Mailing address:
  • Phone: 208-522-4600
  • Fax: 208-552-7521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM7271
License Number StateID

VIII. Authorized Official

Name: MRS. JAMIE L HOWARD
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 208-522-4600