Provider Demographics
NPI:1821525452
Name:HOFMANN, KRISTIN MESHELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MESHELLE
Last Name:HOFMANN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2579 N COPPERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-5295
Mailing Address - Country:US
Mailing Address - Phone:208-870-6521
Mailing Address - Fax:
Practice Address - Street 1:420 W MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7363
Practice Address - Country:US
Practice Address - Phone:208-426-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID55631363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care