Individual
KRISTINA COFFEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3101 E STATE ST, EAGLE, ID 83616-6232
(208) 473-3100
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-01856
NC
363A00000X
Physician Assistant
Primary
PA-2327
ID
Other
Enumeration date
06/21/2009
Last updated
05/12/2023
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