Provider Demographics
NPI:1558620781
Name:INMAN, KANDISS L (WHNP-BC, MSN, NCMP)
Entity Type:Individual
Prefix:MRS
First Name:KANDISS
Middle Name:L
Last Name:INMAN
Suffix:
Gender:F
Credentials:WHNP-BC, MSN, NCMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 W EMERALD ST STE C200
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2074
Mailing Address - Country:US
Mailing Address - Phone:208-780-9295
Mailing Address - Fax:855-490-9559
Practice Address - Street 1:4477 W EMERALD ST STE C200
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2074
Practice Address - Country:US
Practice Address - Phone:208-780-9295
Practice Address - Fax:855-490-9559
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-38712163W00000X
IDNP-1050A163W00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse