Provider Demographics
NPI:1083855399
Name:FELT, KARY MAX LEWIS (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:KARY
Middle Name:MAX LEWIS
Last Name:FELT
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83211-1362
Mailing Address - Country:US
Mailing Address - Phone:208-226-3200
Mailing Address - Fax:
Practice Address - Street 1:502 TYHEE AVE
Practice Address - Street 2:
Practice Address - City:AMERICAN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83211-1224
Practice Address - Country:US
Practice Address - Phone:208-226-1057
Practice Address - Fax:208-240-6720
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily