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1346970324 NPI number — KELSEY ANN EYOLFSON PA

NPI Number: 1346970324
Health Care Provider/Practitioner: KELSEY ANN EYOLFSON PA

Information about “1346970324” NPI (KELSEY ANN EYOLFSON PA) exists in 1346970324 in HTML format HTML  |  1346970324 in plain Text format TXT  |  1346970324 in PDF (Portable Document Format) PDF  |  1346970324 in an XML format XML  formats.

NPI Number : 1346970324 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346970324",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EYOLFSON",
    "FirstName": "KELSEY",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ROPA",
    "OtherFirstName": "KELSEY",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 191050",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOISE",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83719-1050",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-955-6500",
    "MailingAddressFaxNumber": "208-955-6501",
    "FirstLinePracticeLocationAddress": "1474 N MERIDIAN RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KUNA",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83634-2041",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-809-2885",
    "PracticeLocationAddressFaxNumber": "208-809-2886",
    "EnumerationDate": "06/13/2022",
    "LastUpdateDate": "03/25/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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