Basic Information
| Provider Information | |||||||||
| NPI: | 1871737973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | KAYE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3525 E LOUISE DR STE 195 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836426303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088468335 | ||||||||
| FaxNumber: | 2088468336 | ||||||||
| Practice Location | |||||||||
| Address1: | 3525 E LOUISE DR STE 195 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088468335 | ||||||||
| FaxNumber: | 2088468336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2009 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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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 | 207R00000X | 7771762-1204 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | O-0858 | ID | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.