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General NPI Number Information
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NPI Number | 1235696287
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Entity Type | Individual
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Provider Name | RACHEL JANETTE KALLEMEYN FNP
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Gender | Female
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 7173 E SUPER 1 LOOP STE B
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City | ATHOL
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State | ID
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Zip | 83801-7109
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Country | US
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Telephone | 208-561-9901
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Fax | 208-561-9968
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Provider Business Mailing Address
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Address Line | 1593 E POLSTON AVE
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City | POST FALLS
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State | ID
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Zip | 83854-5326
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Country | US
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Telephone | 208-262-2300
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Fax | 208-262-2349
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95011208
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6361073
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License Number State | ID
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