Provider Demographics
NPI:1639495708
Name:BELL, KRYSTEN MARIE
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:MARIE
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTEN
Other - Middle Name:MARIE
Other - Last Name:BOTIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2178 S MYERS PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5503
Mailing Address - Country:US
Mailing Address - Phone:909-647-8614
Mailing Address - Fax:
Practice Address - Street 1:2178 S MYERS PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5503
Practice Address - Country:US
Practice Address - Phone:909-647-8614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74281207X00000X
CAA118962207X00000X
IDM-13270207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery