Individual
KRISTA TICKEMYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1919 LINCOLN WAY STE 415, COEUR D ALENE, ID 83814
(208) 625-4595
(208) 625-4596
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5059
(208) 625-5731
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N-35924
ID
363L00000X
Nurse Practitioner
Primary
N-40239
ID
363LF0000X
Family Nurse Practitioner
NP-1596A
ID
Other
Enumeration date
08/19/2015
Last updated
07/25/2025
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