Healthcare Provider Details

I. General information

NPI: 1992147201
Provider Name (Legal Business Name): KATHRYN HINDS FUHRIMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN ANNE HINDS PA

II. Dates (important events)

Enumeration Date: 07/27/2013
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3217 BAVARIA STREET
EAGLE ID
83616
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-6200
  • Fax: 208-302-6255
Mailing address:
  • Phone: 208-302-6200
  • Fax: 208-302-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-1096
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: