Kyle Randall Peterman, FNP
Nurse Practitioner, Family in Boise, ID. Individual provider (NPI-1).
NPI number1639879596
StatusActive
Last updated in NPPESJul 25, 2024
Details
- NPI
- 1639879596
- Entity type
- Individual (NPI-1)
- Name
- Kyle Randall Peterman
- Credential
- FNP
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 8, 2023
- Certification date
- Jul 25, 2024
- Last updated
- Jul 25, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 57854 | ID | Yes |
Practice location
500 W Fort StBoise, ID 83702-4501
Phone 208-422-1000
Mailing address
500 W Fort StBoise, ID 83702-4599
Phone 208-422-1000
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