Provider Demographics
NPI:1043003064
Name:PRESCOTT, KRISTIN MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4386 S TRAILRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-6642
Mailing Address - Country:US
Mailing Address - Phone:208-859-6488
Mailing Address - Fax:
Practice Address - Street 1:3165 E GREENHURST RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-8655
Practice Address - Country:US
Practice Address - Phone:208-463-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8171965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily