Healthcare Provider Details

I. General information

NPI: 1093813461
Provider Name (Legal Business Name): KIM B BRIGGS M.S. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 MERLIN DR STE 200
IDAHO FALLS ID
83404-7405
US

IV. Provider business mailing address

3345 MERLIN DR STE 200
IDAHO FALLS ID
83404-7405
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-1514
  • Fax: 208-529-3170
Mailing address:
  • Phone: 208-529-1514
  • Fax: 208-529-3170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberHA-1030
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD-1095
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: