Provider Demographics
NPI:1164018123
Name:KRAINCHICH, BRIANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:KRAINCHICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:243 CHENEY DR W STE 200
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4278
Mailing Address - Country:US
Mailing Address - Phone:208-736-7422
Mailing Address - Fax:
Practice Address - Street 1:243 CHENEY DR W STE 200
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4278
Practice Address - Country:US
Practice Address - Phone:208-390-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1967363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant