Healthcare Provider Details

I. General information

NPI: 1053644898
Provider Name (Legal Business Name): MEGAN CORY MCINTYRE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W DEER FLAT RD
KUNA ID
83634-1275
US

IV. Provider business mailing address

825 W DEER FLAT RD
KUNA ID
83634-1275
US

V. Phone/Fax

Practice location:
  • Phone: 208-922-3355
  • Fax: 678-553-1263
Mailing address:
  • Phone: 208-922-3355
  • Fax: 678-553-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: