Provider Demographics
NPI:1376647909
Name:KACIN, RAQUEL RENEE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:RENEE
Last Name:KACIN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 E JADE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7697
Mailing Address - Country:US
Mailing Address - Phone:757-934-4661
Mailing Address - Fax:
Practice Address - Street 1:3167 WEST BELLTOWER DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:208-908-7797
Practice Address - Fax:208-908-6588
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN000865363LF0000X
NVRN25040163WG0000X
ID77590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice