NPI 1619694312

Zachary Kinney, RECOVERYCOACH

Practitioner Peer Specialist Pocatello, ID

Practice location

Address: 5230 W Moonlight Mine Rd, Pocatello, ID 83201-9013
Phone: (208) 478-0219
Fax: (208) 944-9655
Mailing address: 32 Ravine Dr, Pocatello, ID 83204-4031

Registered specialties

Peer Specialist Primary

Other Service Providers Taxonomy 175T00000X Licence 13056 (ID)

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Registry record

NPI: 1619694312
Entity type: Individual
Sex (as registered): Male
NPI issued: 24 Oct 2022
Record last updated: 24 Oct 2022

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.