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General NPI Number Information
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NPI Number | 1033877527
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Entity Type | Individual
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Provider Name | TIFFANY KEARNY PA
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Gender | Female
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 900 N LIBERTY ST STE 400
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City | BOISE
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State | ID
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Zip | 83704-8707
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Country | US
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Telephone | 208-367-7423
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Fax |
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Provider Business Mailing Address
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Address Line | 3691 N BONNIE LN
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City | BOISE
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State | ID
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Zip | 83703-4253
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Country | US
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Telephone | 208-880-0208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | PA-2176
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-2176
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License Number State | ID
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