Healthcare Provider Details

I. General information

NPI: 1497310411
Provider Name (Legal Business Name): KAYLIE SYLVESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLIE A AAKER

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FOREST ST
MCCALL ID
83638-5256
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-630-2470
  • Fax:
Mailing address:
  • Phone:
  • Fax: 509-482-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA.60941453
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60941453
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2553
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: