Provider Demographics
NPI:1124398458
Name:DOMBY, KYLEE MIRANDA (NP)
Entity type:Individual
Prefix:MS
First Name:KYLEE
Middle Name:MIRANDA
Last Name:DOMBY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-6130
Mailing Address - Fax:208-367-7316
Practice Address - Street 1:1000 N CURTIS RD
Practice Address - Street 2:STE 305
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-367-6130
Practice Address - Fax:208-367-7316
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDNP-1088A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily