Provider Demographics
NPI:1104878396
Name:HITE, KATHRYN S (NP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:HITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-887-4775
Mailing Address - Fax:208-888-1344
Practice Address - Street 1:3140 W MILANO DR
Practice Address - Street 2:SUITE 150
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7290
Practice Address - Country:US
Practice Address - Phone:208-887-4775
Practice Address - Fax:208-888-1344
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDNP314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20000422Medicare PIN