Healthcare Provider Details

I. General information

NPI: 1578306866
Provider Name (Legal Business Name): KYRRA ELLIE LYNN DOSHIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15098 W LACEY RD
POCATELLO ID
83202-5020
US

IV. Provider business mailing address

15098 W LACEY RD
POCATELLO ID
83202-5020
US

V. Phone/Fax

Practice location:
  • Phone: 208-212-2125
  • Fax:
Mailing address:
  • Phone: 208-212-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberID000029989E
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: