Basic Information
| Provider Information | |||||||||
| NPI: | 1255706461 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIENLEN | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MS, AG-ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 PINE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837163109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083432745 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1075 N CURTIS RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837061300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083678333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2015 | ||||||||
| LastUpdateDate: | 12/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | NP-1669A | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.