Provider Demographics
NPI:1578012134
Name:STEELE, KANDRALYN (PPCNP-BC)
Entity type:Individual
Prefix:
First Name:KANDRALYN
Middle Name:
Last Name:STEELE
Suffix:
Gender:F
Credentials:PPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1407
Mailing Address - Street 2:SUITE 16
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-1407
Mailing Address - Country:US
Mailing Address - Phone:208-992-5109
Mailing Address - Fax:208-237-9029
Practice Address - Street 1:190 BULLOCK ST.
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-1928
Practice Address - Country:US
Practice Address - Phone:208-992-5109
Practice Address - Fax:208-237-9029
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID69207363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics