Provider Demographics
NPI:1871181156
Name:CONNER, KABRYA A
Entity Type:Individual
Prefix:
First Name:KABRYA
Middle Name:A
Last Name:CONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 S HARRINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6096
Mailing Address - Country:US
Mailing Address - Phone:208-724-4921
Mailing Address - Fax:
Practice Address - Street 1:5880 S HARRINGTON WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-6096
Practice Address - Country:US
Practice Address - Phone:208-724-4921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician