Provider Demographics
NPI:1457130767
Name:GAMETTE, KELLI KJAR (FNP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:KJAR
Last Name:GAMETTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E HERITAGE PARK ST STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5800
Mailing Address - Country:US
Mailing Address - Phone:208-563-3595
Mailing Address - Fax:208-563-3592
Practice Address - Street 1:1500 E HERITAGE PARK ST STE 150
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5800
Practice Address - Country:US
Practice Address - Phone:208-563-3595
Practice Address - Fax:208-563-3592
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID58292364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health