Kelly Russell, MSN,RN,FNP-BC
Nurse Practitioner in Boise, ID. Individual provider (NPI-1).
NPI number1669938320
StatusActive
Last updated in NPPESJun 29, 2026
Details
- NPI
- 1669938320
- Entity type
- Individual (NPI-1)
- Name
- Kelly Russell
- Credential
- MSN,RN,FNP-BC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 18, 2019
- Certification date
- Jun 29, 2026
- Last updated
- Jun 29, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | 79075 | ID | Yes |
| 363LF0000X | Nurse Practitioner, Family | 95008457 | CA |
Practice location
900 N Liberty St Ste 101Boise, ID 83704-8858
Phone 208-367-8787
Mailing address
Po Box 190930Boise, ID 83719-0930
Phone 208-302-9342 · Fax 208-367-5180
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