Provider Demographics
NPI:1053609073
Name:NEARY, KAITLIN C (MD)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:C
Last Name:NEARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8950 W EMERALD ST STE 168
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8296
Mailing Address - Country:US
Mailing Address - Phone:208-321-1209
Mailing Address - Fax:208-321-1211
Practice Address - Street 1:8950 W EMERALD ST STE 168
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8296
Practice Address - Country:US
Practice Address - Phone:208-321-1209
Practice Address - Fax:208-321-1211
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16821207XX0004X, 207X00000X
NE6556207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
13885664OtherCAQH
NV1053609073Medicaid
NVV115462Medicare PIN