Healthcare Provider Details

I. General information

NPI: 1235043621
Provider Name (Legal Business Name): KERRY ANN RENNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR
KETCHUM ID
83340
US

IV. Provider business mailing address

608 N 1ST AVE
HAILEY ID
83333-7002
US

V. Phone/Fax

Practice location:
  • Phone: 208-726-5027
  • Fax:
Mailing address:
  • Phone: 208-721-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number36361
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: