Healthcare Provider Details

I. General information

NPI: 1801567110
Provider Name (Legal Business Name): KINSLEY BONFILIO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2021
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N CURTIS RD STE 303
BOISE ID
83706-1347
US

IV. Provider business mailing address

1000 N CURTIS RD STE 303
BOISE ID
83706-1347
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-4000
  • Fax:
Mailing address:
  • Phone: 208-377-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2094
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: