Healthcare Provider Details

I. General information

NPI: 1265887772
Provider Name (Legal Business Name): KIRK BIGLEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W BANNOCK ST
BOISE ID
83702-6035
US

IV. Provider business mailing address

425 W BANNOCK ST
BOISE ID
83702-6035
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-6458
  • Fax:
Mailing address:
  • Phone: 208-343-6458
  • Fax: 208-343-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52212
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2167
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: