Healthcare Provider Details

I. General information

NPI: 1477714285
Provider Name (Legal Business Name): KARA KELLY HILL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MAIN ST STE 100
BOISE ID
83702-7307
US

IV. Provider business mailing address

111 MAIN ST STE 100
BOISE ID
83702-7307
US

V. Phone/Fax

Practice location:
  • Phone: 208-342-5900
  • Fax: 208-342-2088
Mailing address:
  • Phone: 208-342-5900
  • Fax: 208-342-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP500A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: