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General NPI Number Information
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NPI Number | 1740786631
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Entity Type | Individual
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Provider Name | KELLY LAUREN BLOCK DO
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Gender | Female
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Dates
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Enumeration Date | 04/01/2018
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 1072 N LIBERTY ST STE 303
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City | BOISE
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State | ID
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Zip | 83704-8708
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Country | US
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Telephone | 208-302-4200
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Fax | 208-302-4255
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Provider Business Mailing Address
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Address Line | PO BOX 190930
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City | BOISE
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State | ID
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Zip | 83719-0930
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Country | US
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Telephone | 208-367-5170
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Fax | 208-367-5180
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | DO209500
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License Number State | OR
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Taxonomy #2
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | O-1968
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License Number State | ID
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