NPI 1114405396

Ryan Blair Killpack, PAC

Practitioner Medical Physician Assistant Blackfoot, ID

Practice location

Address: 98 Poplar St, Blackfoot, ID 83221-1758
Phone: (208) 785-4100

Registered specialties (2)

Medical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X

Other Physician Assistant providers in Idaho →

Surgical Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AS0400X

Registry record

NPI: 1114405396
Entity type: Individual
Sex (as registered): Male
NPI issued: 31 Jul 2018
Record last updated: 31 Jul 2018

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.