Provider Demographics
NPI:1134198088
Name:THEIS, KRISTINE LYNN (NP)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:LYNN
Last Name:THEIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:LYNN
Other - Last Name:KRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, FNP
Mailing Address - Street 1:1286 E GRAND CANYON ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646
Mailing Address - Country:US
Mailing Address - Phone:208-888-1183
Mailing Address - Fax:
Practice Address - Street 1:444 W FORT ST FL 2
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4535
Practice Address - Country:US
Practice Address - Phone:208-422-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily