Provider Demographics
NPI:1235696287
Name:KALLEMEYN, RACHEL JANETTE (FNP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:JANETTE
Last Name:KALLEMEYN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:JANETTE
Other - Last Name:HUDLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1593 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5326
Mailing Address - Country:US
Mailing Address - Phone:208-262-2300
Mailing Address - Fax:208-262-2349
Practice Address - Street 1:7173 E SUPER 1 LOOP STE B
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:ID
Practice Address - Zip Code:83801-7109
Practice Address - Country:US
Practice Address - Phone:208-561-9901
Practice Address - Fax:208-561-9968
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011208363LF0000X
ID6361073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1235696287Medicaid
CATHP11576FMedicaid