Individual
MS. KRYSTA NICOLE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
108 E IDAHO AVE, HOMEDALE, ID 83628-5003
(208) 337-3189
(208) 466-5359
Mailing address
PO BOX 9, NAMPA, ID 83653-0009
(208) 467-4431
(208) 467-7684
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5081403
ID
363A00000X
Physician Assistant
PA51782
CA
Other
Enumeration date
07/27/2014
Last updated
06/05/2026
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