Provider Demographics
NPI:1396023446
Name:KINGHORN, KURT EARL (DPM)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:EARL
Last Name:KINGHORN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 W CAYUSE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4795
Mailing Address - Country:US
Mailing Address - Phone:208-344-3324
Mailing Address - Fax:208-344-4349
Practice Address - Street 1:1540 W CAYUSE CREEK DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-4795
Practice Address - Country:US
Practice Address - Phone:208-344-3324
Practice Address - Fax:208-344-4349
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-230213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1396023446Medicaid