Healthcare Provider Details

I. General information

NPI: 1760191340
Provider Name (Legal Business Name): KYLEE E SCHAAT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYLEE E SMITH

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 S 1ST E STE 101
REXBURG ID
83440-1902
US

IV. Provider business mailing address

PO BOX 18
SAINT ANTHONY ID
83445-0018
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-4900
  • Fax: 208-356-3724
Mailing address:
  • Phone: 208-356-4900
  • Fax: 208-624-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number74550
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: