Provider Demographics
NPI:1740679356
Name:BOWER, KYIRSTY (FNP)
Entity type:Individual
Prefix:
First Name:KYIRSTY
Middle Name:
Last Name:BOWER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KYIRSTY
Other - Middle Name:
Other - Last Name:UNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-9342
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:6533 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8737
Practice Address - Country:US
Practice Address - Phone:208-302-5200
Practice Address - Fax:208-302-5225
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202005744NP363LF0000X
WAAP61163603363LF0000X
ID73106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily