Provider Demographics
NPI:1740083047
Name:KAISER, AMY SUZANNE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUZANNE
Last Name:KAISER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SUZANNE
Other - Last Name:VOLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:414 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-3841
Mailing Address - Country:US
Mailing Address - Phone:208-681-0094
Mailing Address - Fax:
Practice Address - Street 1:1820 E 17TH ST STE 355
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6453
Practice Address - Country:US
Practice Address - Phone:208-681-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program