Provider Demographics
NPI:1114489788
Name:KUNA HEALTHCARE CLINIC, PLLC
Entity Type:Organization
Organization Name:KUNA HEALTHCARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYLEEN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:208-565-0978
Mailing Address - Street 1:943 N LINDER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-3395
Mailing Address - Country:US
Mailing Address - Phone:208-565-0978
Mailing Address - Fax:208-902-3834
Practice Address - Street 1:943 N LINDER RD STE 103
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-3395
Practice Address - Country:US
Practice Address - Phone:208-565-0978
Practice Address - Fax:208-902-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDIDTPID013642Medicaid