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General NPI Number Information
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NPI Number | 1376647909
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Entity Type | Individual
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Provider Name | RAQUEL RENEE KACIN APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 3167 WEST BELLTOWER DRIVE SUITE 120
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City | MERIDIAN
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State | ID
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Zip | 83646
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Country | US
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Telephone | 208-908-7797
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Fax | 208-908-6588
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Provider Business Mailing Address
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Address Line | 1909 E JADE CREEK LN
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City | EAGLE
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State | ID
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Zip | 83616-7697
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Country | US
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Telephone | 757-934-4661
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN000865
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN25040
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 77590
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License Number State | ID
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