Individual
KRISTI L GRIGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
167 E 1ST S, RIGBY, ID 83442-1401
(208) 745-8747
(208) 745-9396
Mailing address
167 E 1ST S, RIGBY, ID 83442-1401
(208) 745-8747
(208) 745-9396
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA467
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806708000
—
ID
01
—
PA-467
STATE LICENSE
ID
Enumeration date
07/19/2006
Last updated
05/08/2013
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