Healthcare Provider Details

I. General information

NPI: 1174069421
Provider Name (Legal Business Name): MCKINLEY MARLOWE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MCKINLEY MCMULLIN

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14601 S PLEASANT VALLEY RD
KUNA ID
83634-2728
US

IV. Provider business mailing address

14601 S PLEASANT VALLEY RD
KUNA ID
83634-2728
US

V. Phone/Fax

Practice location:
  • Phone: 208-614-6583
  • Fax:
Mailing address:
  • Phone: 208-614-6583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2542
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: