Provider Demographics
NPI:1457839730
Name:IN BALANCE: INTEGRATIVE PRIMARY HEALTHCARE PLLC
Entity Type:Organization
Organization Name:IN BALANCE: INTEGRATIVE PRIMARY HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-C
Authorized Official - Phone:208-242-3723
Mailing Address - Street 1:1017 E YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5237
Mailing Address - Country:US
Mailing Address - Phone:208-425-6444
Mailing Address - Fax:208-425-6477
Practice Address - Street 1:1017 E YOUNG ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5237
Practice Address - Country:US
Practice Address - Phone:208-425-6444
Practice Address - Fax:208-425-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1287A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty