Provider Demographics
NPI:1750342952
Name:BILLS, KEBAI DAWN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:KEBAI
Middle Name:DAWN
Last Name:BILLS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:KEBAI
Other - Middle Name:DAWN
Other - Last Name:GAMBLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1777 E. CLARK, SUITE # 210
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-233-5433
Mailing Address - Fax:877-284-2783
Practice Address - Street 1:1777 E. CLARK SUITE # 210
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-233-5433
Practice Address - Fax:877-284-2783
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA520363AM0700X
ID520363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPA 520OtherPHYSICIAN ASSISTANT LICEN
IDPA 520OtherPHYSICIAN ASSISTANT LICEN
IDPA 520OtherPHYSICIAN ASSISTANT LICEN