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Kelly L Dustin, DO
Student in an Organized Health Care Education/Training Program in Rexburg, Idaho
NPI 1114957362

Kelly L Dustin is a Student in an Organized Health Care Education/Training Program based in Twin Falls, ID. Kelly L Dustin practices in Rexburg, ID and has the professional credentials of DO. The NPI Number for Kelly L Dustin is 1114957362 and holds a License No. O-0459 (Idaho).

The current practice location address for Kelly L Dustin is 21 Winn Dr, Rexburg, ID and can be reached out via phone at 208-881-5222 and via fax at 877-441-4715.

Location: 21 Winn Dr, Rexburg, ID, 83301-6856
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1114957362
Provider Name
Kelly L Dustin
Credential
DO
Provider Entity Type
Individual
Gender
Male
Address
21 Winn Dr, Rexburg, ID, 83301-6856
Phone Number
208-881-5222
Fax Number
877-441-4715
Provider Enumeration Date
07/04/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
8035175 05 ID
institution
Provider Business Practice Location Address Details
Address
21 Winn Dr
City
Rexburg
State
Idaho
Zip
83440-5277
Phone Number
208-881-5222
Fax Number
877-441-4715
person
Provider Business Mailing Address Details
Address
21 Winn Dr
City
Rexburg
State
Idaho
Zip
83440-5277
Phone Number
208-881-5222
Fax Number
877-441-4715
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
-
Taxonomy
207Q00000X
License No.
MR0875 (Idaho)
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
O-0459 (Idaho)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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