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Individual

MRS. CRYSTA KIMES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
910 NW 16TH ST STE 101, FRUITLAND, ID 83619-2265
(208) 452-8000
Mailing address
18616 EASTER PEAK AVE, NAMPA, ID 83687-8115
(208) 850-9300

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary

Other

Enumeration date
05/18/2018
Last updated
05/18/2018
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