Provider Demographics
NPI:1366453524
Name:SCHELHAAS, KRISTYN A (DO)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:A
Last Name:SCHELHAAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTYN
Other - Middle Name:
Other - Last Name:AXTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-955-6500
Mailing Address - Fax:208-955-6501
Practice Address - Street 1:1375 N HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5280
Practice Address - Country:US
Practice Address - Phone:208-809-2869
Practice Address - Fax:208-809-2861
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR7928207Q00000X
ID0-0528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8084196Medicaid
ID8084196Medicaid
RES0000Medicare UPIN