Provider Demographics
NPI:1649396177
Name:WAYMENT, KRISTI L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:L
Last Name:WAYMENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 S. FEDERAL WAY
Mailing Address - Street 2:STE. 103, #341
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705
Mailing Address - Country:US
Mailing Address - Phone:208-631-5257
Mailing Address - Fax:208-433-1738
Practice Address - Street 1:916 E. WRIGHT ST.
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-631-5257
Practice Address - Fax:208-433-1738
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA325363A00000X
IDPA-325363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806326700Medicaid
ID806326700Medicaid