Individual
KYRSTANNE KAYE IDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
228 S TAWNY DR, GRANTSVILLE, UT 84029-5028
(801) 580-9139
Mailing address
228 S TAWNY DR, GRANTSVILLE, UT 84029-5028
(801) 580-9139
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
UT
Other
Enumeration date
10/21/2025
Last updated
10/21/2025
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