Provider Demographics
NPI:1629627575
Name:UNRUH, KRISTY L (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:L
Last Name:UNRUH
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
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 145
Mailing Address - Street 2:
Mailing Address - City:ARCO
Mailing Address - State:ID
Mailing Address - Zip Code:83213-0145
Mailing Address - Country:US
Mailing Address - Phone:208-252-7654
Mailing Address - Fax:
Practice Address - Street 1:551 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:ARCO
Practice Address - State:ID
Practice Address - Zip Code:83213-5003
Practice Address - Country:US
Practice Address - Phone:208-252-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID62605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily