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General NPI Number Information
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NPI Number | 1336930734
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Entity Type | Individual
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Provider Name | KYLE SPENCER CONGER RN
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Gender | Male
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 1202 E LOCUST ST
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City | EMMETT
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State | ID
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Zip | 83617-2715
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Country | US
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Telephone | 208-901-3287
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Fax | 208-365-3572
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Provider Business Mailing Address
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Address Line | 11360 W BLUE FOX ST
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City | BOISE
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State | ID
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Zip | 83709-6917
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Country | US
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Telephone | 801-347-0160
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 51549
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 51549
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License Number State | ID
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