Healthcare Provider Details

I. General information

NPI: 1093643041
Provider Name (Legal Business Name): PATRICK KEVIN REXROAT LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SHOSHONE ST E
TWIN FALLS ID
83301-6105
US

IV. Provider business mailing address

222 SHOSHONE ST E
TWIN FALLS ID
83301-6105
US

V. Phone/Fax

Practice location:
  • Phone: 208-370-8288
  • Fax:
Mailing address:
  • Phone: 208-370-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: