Healthcare Provider Details

I. General information

NPI: 1932138757
Provider Name (Legal Business Name): REBECCA D KEMP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/30/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6488 CHINOOK ST KEMPPA@AOL.COM
BONNERS FERRY ID
83805-7515
US

IV. Provider business mailing address

6488 CHINOOK KEMPPA@AOL.COM
BONNERS FERRY ID
83805-7515
US

V. Phone/Fax

Practice location:
  • Phone: 208-267-8710
  • Fax: 888-972-7960
Mailing address:
  • Phone: 208-267-8710
  • Fax: 888-972-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA631
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA-2112
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: