Healthcare Provider Details

I. General information

NPI: 1235745365
Provider Name (Legal Business Name): KATHLEEN FRANCIS BROWN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN FRANCIS NEMETH

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 08/05/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N MAIN
RIGGINS ID
83549
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-628-3666
  • Fax: 208-628-3187
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1929
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: