Individual
ANDREA KROGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
701 LEWISTON STREET, COTTONWOOD, ID 83522-0565
(208) 962-3267
(208) 962-2313
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 962-3251
(208) 962-2313
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA327
ID
363AM0700X
Medical Physician Assistant
Primary
PA327
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922018027
BLUE CROSS OF IDAHO
ID
05
—
1922018027
—
ID
05
—
805010100
—
ID
01
—
8B529
BCBS
ID
Enumeration date
08/09/2006
Last updated
08/06/2021
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