Healthcare Provider Details

I. General information

NPI: 1225904907
Provider Name (Legal Business Name): KYLE GEBS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 10/11/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 POTOMAC WAY
IDAHO FALLS ID
83404-4950
US

IV. Provider business mailing address

4290 SAINT ARBOR LN
IDAHO FALLS ID
83401-1293
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-7666
  • Fax: 208-524-2821
Mailing address:
  • Phone: 208-821-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1371783
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: