Provider Demographics
NPI:1093520298
Name:KILLMAR, CODY DEAN (PARAMEDIC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:DEAN
Last Name:KILLMAR
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HEATH DR
Mailing Address - Street 2:
Mailing Address - City:RIGGINS
Mailing Address - State:ID
Mailing Address - Zip Code:83549-5011
Mailing Address - Country:US
Mailing Address - Phone:208-983-9263
Mailing Address - Fax:
Practice Address - Street 1:126 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RIGGINS
Practice Address - State:ID
Practice Address - Zip Code:83549-0055
Practice Address - Country:US
Practice Address - Phone:208-628-3394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID170373146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic