Healthcare Provider Details

I. General information

NPI: 1144212689
Provider Name (Legal Business Name): KIMBERLY KAHLER STUTZMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY RENEE KAHLER MD

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N RAYMOND ST
BOISE ID
83704-9251
US

IV. Provider business mailing address

777 N RAYMOND ST
BOISE ID
83704-9251
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-6042
  • Fax: 208-322-7018
Mailing address:
  • Phone: 208-367-6042
  • Fax: 208-322-7018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0031115
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD19694
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM9972
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: