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General NPI Number Information
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NPI Number | 1922959402
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Entity Type | Individual
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Provider Name | KELLY KANDES-MYERS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 3224 N MERIDIAN RD STE 110
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City | MERIDIAN
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State | ID
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Zip | 83646-6232
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Country | US
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Telephone | 208-395-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 4578 W FERN VISTA CT
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City | MERIDIAN
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State | ID
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Zip | 83646-1434
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Country | US
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Telephone | 510-502-2697
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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 | 4771790
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License Number State | ID
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