Provider Demographics
NPI:1255636304
Name:LEBARON, KATHY (LM, CPM)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LEBARON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 RANDY DR
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1712
Mailing Address - Country:US
Mailing Address - Phone:208-351-1823
Mailing Address - Fax:208-745-8924
Practice Address - Street 1:297N 3855 EAST
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442
Practice Address - Country:US
Practice Address - Phone:208-745-7571
Practice Address - Fax:208-745-8924
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID - 19176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife