Healthcare Provider Details

I. General information

NPI: 1124506191
Provider Name (Legal Business Name): KARRIE RAE KONDEL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 BENNETT AVE
BURLEY ID
83318-2676
US

IV. Provider business mailing address

794 EASTLAND DR
TWIN FALLS ID
83301-6856
US

V. Phone/Fax

Practice location:
  • Phone: 208-678-7796
  • Fax: 360-838-2450
Mailing address:
  • Phone: 208-737-6718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP60883009
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59307
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: