Provider Demographics
NPI:1457985848
Name:ATKINSON, KRISTIE RACHELE (MED)
Entity Type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:RACHELE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:KRISTIE
Other - Middle Name:RACHELE
Other - Last Name:ATKINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:319 N CHAMBERS PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1610
Mailing Address - Country:US
Mailing Address - Phone:662-801-1680
Mailing Address - Fax:
Practice Address - Street 1:319 N CHAMBERS PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1610
Practice Address - Country:US
Practice Address - Phone:662-801-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty