RYAN BLAIR KILLPACK


Address: 98 Poplar St, Blackfoot, ID 83221-1758
Phone: 2087854100

RYAN BLAIR KILLPACK (NPI# 1114405396) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1114405396
Entity Type Individual
Full Name RYAN BLAIR KILLPACK
Credential PA-C
Practice Address 98 Poplar St
Blackfoot
ID 83221-1758
Practice Telephone 2087854100
Mailing Telephone 2087854100
Enumeration Date 2018-07-31
Last Update Date 2018-07-31
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AM0700X Physician Assistant
Specialization: Medical
Physician Assistants & Advanced Practice Nursing Providers
N 363AS0400X Physician Assistant
Specialization: Surgical Technologist
Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 98 POPLAR ST
City BLACKFOOT
State ID
Zip Code 83221-1758

Providers in the same location

NPI Name Taxonomy Address Enumeration
1609871474 Wade H Flowers Jr. Pharmacist 98 Poplar St, Blackfoot, ID 83221-1758 2005-06-16
1629685177 Lucus Craig Webb Christoffersen Registered Nurse 98 Poplar St, Blackfoot, ID 83221-1799 2020-09-29
1770111924 Kywnynn Madsen Dietitian, Registered 98 Poplar St, Blackfoot, ID 83221-1758 2020-03-31
1235795915 Megan Lewis Advanced Practice Midwife 98 Poplar St, Blackfoot, ID 83221-1758 2019-05-17
1083177935 Jason Lee Harmon Student in an Organized Health Care Education/Training Program 98 Poplar St, Blackfoot, ID 83221-1758 2019-04-08
1851870091 Jennifer L Wistisen Physician Assistant 98 Poplar St, Blackfoot, ID 83221-1799 2018-08-08
1023504651 Amanda Wray Pharmacist 98 Poplar St, Blackfoot, ID 83221-1758 2018-07-06
1699268276 Zachary D Morrow Nurse Anesthetist, Certified Registered 98 Poplar St, Blackfoot, ID 83221-1758 2018-06-08
1184115107 Megan Nicole Broyles Pharmacist 98 Poplar St, Blackfoot, ID 83221 2018-05-24
1295223493 Carolyn Louise Hansen Nurse Practitioner 98 Poplar St, Blackfoot, ID 83221-1799 2018-04-24
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1932711165 Samantha Paige Averett Social Worker 60 N Broadway, Blackfoot, ID 83221 2020-08-19
1730711656 Sara Marie Letham Family Medicine 33 S Thompson Lane, Blackfoot, ID 83221 2020-02-08
1962994962 Tyler Thomas Wood Student in an Organized Health Care Education/Training Program 98 Poplar Street, Blackfoot, Id 83221, Blackfoot, ID 83221 2018-06-05
1801336276 Bmh, Inc. Internal Medicine 235 Poplar St, Blackfoot, ID 83221 2017-03-03
1497119804 Susan Doran Social Worker 720 E. Alice, Blackfoot, ID 83221 2016-04-12
1427412121 Josie Russell Adkins Counselor 720 East Alice, Blackfoot, ID 83221 2016-04-08
1740590314 Ashley Nichole Thomas Physician Assistant 710 E. Alice Street, Blackfoot, ID 83221 2010-10-18
1528373313 Stephanie Lynn Henderson Dietitian, Registered 1555 Vernon Ave, Blackfoot, ID 83221 2010-08-17
1184850141 Joy H. Taylor Nurse Practitioner 1441 Parkway Drive, Blackfoot, ID 83221 2009-06-04
1427232925 Nathan E. Sneddon Anesthesiology 98 Poplar St Fl 3, Blackfoot, ID 83221 2007-12-20
Find all providers in zip 83221

Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1518157544 Stacy Cooper Physician Assistant 98 Poplar St, Blackfoot, ID 83221-1758 2007-07-26
1912076373 Travis Arlen Christensen Physician Assistant 98 Poplar St, Blackfoot, ID 83221-1758 2006-11-07

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1689217911 David Jeffrey Hanson Physician Assistant 740 Mckinley Ave Ste 100, Kellogg, ID 83837-2693 2019-10-18
1871060681 Travis Henman Physician Assistant 1404 Pomerelle Ave Ste 150, Burley, ID 83318-2012 2018-10-30
1952889685 Cody Mattingly Physician Assistant 14601 S Pleasant Valley Rd, Kuna, ID 83634-2728 2018-08-03
1992174072 Alexa Rhea Physician Assistant 2841 Juniper Dr Ste 2, Lewiston, ID 83501-4719 2015-09-18
1043689441 Derek R Wynn Physician Assistant 607 W Main Street, Grangeville, ID 83530 2015-09-16
1407223274 Michael Kenneth Wucinich Physician Assistant 775 Pole Line Rd W Ste 302, Twin Falls, ID 83301-5823 2015-08-28
1811364177 Ashley Laren Popadics Physician Assistant 1510 12th Ave Rd Ste 200, Nampa, ID 83686-6008 2015-08-21
1073915963 Jessica Bishop Physician Assistant 1499 W Hays St, Boise, ID 83702-5029 2014-09-23
1447652813 Jessea Camille Whitlow Physician Assistant 2392 Addison Ave E, Twin Falls, ID 83301-6745 2014-09-17
1508287061 Heather N Fox Physician Assistant 12273 West Mcmillan Road, Boise, ID 83713 2013-12-30
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Competitor

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City BLACKFOOT
Zip Code 83221

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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