Provider Demographics
NPI:1134987597
Name:CHRISTENSEN, KAYLONI C (NP)
Entity type:Individual
Prefix:
First Name:KAYLONI
Middle Name:C
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1155 YELLOWSTONE AVE
Mailing Address - Street 2:STE D
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4369
Mailing Address - Country:US
Mailing Address - Phone:208-637-9610
Mailing Address - Fax:208-238-6162
Practice Address - Street 1:1155 YELLOWSTONE AVE
Practice Address - Street 2:STE D
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4369
Practice Address - Country:US
Practice Address - Phone:208-637-9610
Practice Address - Fax:208-238-6162
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ID54051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily