Individual
KRISTYN L MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
910 NW 16TH ST STE 101, FRUITLAND, ID 83619-2265
(208) 452-8000
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642
(208) 452-8000
(208) 452-8055
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201810671NP-PP
OR
363L00000X
Nurse Practitioner
Primary
60199
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201810671NP-PP
OREGON STATE BOARD OF NURSING
OR
Enumeration date
11/30/2018
Last updated
01/22/2019
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