Dustin, Kelly L
Dustin, Kelly L is an individual health care provider with primary practice located at 21 Winn Dr , Rexburg ID 83440-5277. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Dustin, Kelly L can be contacted via phone (208) 881-5222.Contact Information
Primary practice address
21 Winn Dr
Rexburg ID 83440-5277
Phone: (208) 881-5222
Fax: (877) 441-4715
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | O-0459 | Idaho |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | MR0875 | Idaho |
Profile Details
| NPI number | 1114957362 |
|---|---|
| LBN Legal business name | Dustin, Kelly L |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 4th, 2006 |
| Last updated | Nov 19th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114957362 | NPPES |
| Idaho | MEDICAID | 8035175 |
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