NPI 1023489085

Kelly Meacham, PAC

Practitioner Physician Assistant Idaho Falls, ID

Practice location

Address: 3389 Merlin Dr, Idaho Falls, ID 83404-7405
Phone: (208) 552-9831

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence PA-1290 (ID)

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Registry record

NPI: 1023489085
Entity type: Individual
Sex (as registered): Male
NPI issued: 15 Oct 2015
Record last updated: 15 Oct 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.