Provider Demographics
NPI:1184115735
Name:KIMES, CRYSTA (PA)
Entity type:Individual
Prefix:MRS
First Name:CRYSTA
Middle Name:
Last Name:KIMES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CRYSTA
Other - Middle Name:
Other - Last Name:KIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:18616 EASTER PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8115
Mailing Address - Country:US
Mailing Address - Phone:208-850-9300
Mailing Address - Fax:
Practice Address - Street 1:910 NW 16TH ST STE 101
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2265
Practice Address - Country:US
Practice Address - Phone:208-452-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical