Healthcare Provider Details

I. General information

NPI: 1619133501
Provider Name (Legal Business Name): AMY J. KAUFFMAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 HILAND AVE
BURLEY ID
83318-2714
US

IV. Provider business mailing address

1945 HILAND AVE P.O. BOX 1060
BURLEY ID
83318-2714
US

V. Phone/Fax

Practice location:
  • Phone: 208-678-0900
  • Fax:
Mailing address:
  • Phone: 208-678-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM-9588
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-267A
License Number StateID

VIII. Authorized Official

Name: DR. AMY J. KAUFFMAN
Title or Position: GENERAL SURGEON
Credential: M.D.
Phone: 208-678-0900