Provider Demographics
NPI:1437715208
Name:HANDYSIDE, KRISTY (CNP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:HANDYSIDE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:SHRADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10524 W THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-7157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:496 SHOUP AVE W STE B
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5043
Practice Address - Country:US
Practice Address - Phone:877-223-8007
Practice Address - Fax:661-725-5252
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT234790363L00000X
WAAP61475074363LF0000X
ID61427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner