Active NPI
Kathleen McGowan
- Obstetrics & Gynecology Physician
- Boise, ID
National Provider Identifier
1730280017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- M4790
- Practice address
- 100 E Idaho St
Suite 400
Boise, ID 83712-6223 - Phone
- (208) 345-5250
- Fax
- (208) 345-2364
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | M4790 | ID | Primary |
Addresses
Primary practice location
100 E Idaho St
Suite 400
Boise, ID 83712-6223
Mailing address
100 E Idaho St
Suite 400
Boise, ID 83712-6223
Phone (208) 345-5250
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003838300 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4790 | ID | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209081600000",
"number": "1730280017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E IDAHO ST",
"address_2": "SUITE 400",
"city": "BOISE",
"state": "ID",
"postal_code": "837126223",
"telephone_number": "208-345-5250",
"fax_number": "208-345-2364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E IDAHO ST",
"address_2": "SUITE 400",
"city": "BOISE",
"state": "ID",
"postal_code": "837126223",
"telephone_number": "208-345-5250",
"fax_number": "208-345-2364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGOWAN",
"first_name": "KATHLEEN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-26",
"last_updated": "2008-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "ID",
"license": "M4790",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003838300",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.