Individual provider · Type 1 NPI
Ryan Blair Killpack, PA-C
Medical Physician Assistant · Blackfoot, ID
NPI number
1114405396
Active
Practice location
98 Poplar St
Blackfoot, ID 83221-1758
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Surgical Physician Assistant | 363AS0400X | None listed |
| Medical Physician Assistant Primary | 363AM0700X | None listed |
Medical Physician Assistant: Definition to come...
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About NPI 1114405396
Ryan Blair Killpack, PA-C's National Provider Identifier is 1114405396, issued on Jul 31, 2018. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Blackfoot, ID. The record was last updated on Jul 31, 2018.