Individual
KRYSTAL RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3425 MERLIN DR, IDAHO FALLS, ID 83404-7430
(208) 528-6653
Mailing address
3425 MERLIN DR, IDAHO FALLS, ID 83404-7430
(208) 528-6653
(208) 528-6676
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2358
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/10/2022
Last updated
10/04/2022
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