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General NPI Number Information
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NPI Number | 1609748854
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Entity Type | Individual
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Provider Name | KYREN TWEEDIE
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Gender | Male
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 3160 E 17TH ST STE 164
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City | AMMON
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State | ID
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Zip | 83406-6784
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Country | US
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Telephone | 208-529-1795
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 E VENTURE WAY APT 9206
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City | POCATELLO
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State | ID
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Zip | 83201-1209
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Country | US
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Telephone | 208-716-8547
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | I71317
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License Number State | ID
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