Provider Demographics
NPI:1518771435
Name:GILLIHAN, KALLI ANN (FNP)
Entity type:Individual
Prefix:
First Name:KALLI
Middle Name:ANN
Last Name:GILLIHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 N CALCUTTA AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7824
Mailing Address - Country:US
Mailing Address - Phone:208-559-3445
Mailing Address - Fax:
Practice Address - Street 1:1861 E OVERLAND RD STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6687
Practice Address - Country:US
Practice Address - Phone:208-921-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2571946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily