| Doctor Name: | MRS. KELLY F. PESNELL |
| NPI Number: | 1992785463 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | NP-579A |
| Business Practice Address: | 215 3rd St Wilder, ID - 83676 |
| Business Phone Number: | 2084827430 |
| Business Fax Number: | 2084827272 |
| Mailing Address: | 29463 Coach Rd, PARMA |
| State: | ID |
| Postal Code: | 836606323 |
| Phone Number: | 2087226689 |
| Fax Number: | |
| NPI Enumeration Date: | 01/19/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | NP-579A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |