Provider Demographics
NPI:1285672378
Name:DEVANEY, KATHRYN (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:DEVANEY
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19159 HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:ID
Mailing Address - Zip Code:83316-5018
Mailing Address - Country:US
Mailing Address - Phone:208-320-2259
Mailing Address - Fax:
Practice Address - Street 1:823 HARRISON ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3925
Practice Address - Country:US
Practice Address - Phone:208-736-2177
Practice Address - Fax:208-736-2113
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP680-A363LP0808X
IDNP680A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807769000Medicaid
1345621OtherPTAN
ID807769000Medicaid
1345621OtherPTAN