Provider Demographics
NPI:1801830112
Name:SEARLE, KATHLEEN L (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:SEARLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:L
Other - Last Name:SEARLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:114 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FIRTH
Mailing Address - State:ID
Mailing Address - Zip Code:83236-1168
Mailing Address - Country:US
Mailing Address - Phone:208-346-6614
Mailing Address - Fax:208-346-6638
Practice Address - Street 1:114 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FIRTH
Practice Address - State:ID
Practice Address - Zip Code:83236-1168
Practice Address - Country:US
Practice Address - Phone:208-346-6614
Practice Address - Fax:208-346-6638
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP657A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily