Individual
KOLTON HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2325 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 557-2700
Mailing address
3920 N FLINT AVE, IDAHO FALLS, ID 83401-6381
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
157535
ID
Other
Enumeration date
09/08/2025
Last updated
12/23/2025
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