MEDICARE: KYLA MEGAN WOOLEY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2018002195	MO
2	363A00000X	Physician Assistant	PA-1906	ID

General Provider Information

NPI Number	:	1245738038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLA MEGAN WOOLEY PA

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2619 W FAIRVIEW AVE STE 2100
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-6722
Country	:	US
Telephone Number	:	208-706-2663
Fax Number	:	208-489-4300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	09/25/2024

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Directions to “ KYLA MEGAN WOOLEY PA” Practice Location

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