Provider Demographics
NPI:1437028834
Name:GROTHJAN, KRYSTLE BETH (NP)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:BETH
Last Name:GROTHJAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1983
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-9998
Mailing Address - Country:US
Mailing Address - Phone:208-792-7274
Mailing Address - Fax:
Practice Address - Street 1:211 W FOREST STREET
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-9998
Practice Address - Country:US
Practice Address - Phone:208-630-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID57716208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice