MEDICARE: MCKENNA ANNE BRINKMAN

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		ID

General Provider Information

NPI Number	:	1760164917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENNA ANNE BRINKMAN

Provider Business Mailing Address
First Line	:	PO BOX 191050
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83719-1050
Country	:	US
Telephone Number	:	208-955-6500
Fax Number	:	208-955-6501

Provider Business Practice Location Address
First Line	:	3280 E LANARK ST
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-5983
Country	:	US
Telephone Number	:	208-895-8670
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	01/29/2026

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Directions to “ MCKENNA ANNE BRINKMAN ” Practice Location

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