Provider Demographics
NPI:1841376241
Name:ADAMSON, KRISTA S (PNP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:S
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W IRONWOOD DR
Mailing Address - Street 2:SUITE 155
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2656
Mailing Address - Country:US
Mailing Address - Phone:208-667-0585
Mailing Address - Fax:208-667-0876
Practice Address - Street 1:1414 N VERCLER RD BLDG 1
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1092
Practice Address - Country:US
Practice Address - Phone:509-928-6383
Practice Address - Fax:509-926-9420
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP562363LP0200X
WAAP60958277363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806340100Medicaid
IDNPPQ6OtherBLUE CROSS OF IDAHO
WA9634577Medicaid
IDNPKO5OtherBLUE CROSS
ID000010138449OtherREGENCE BLUE SHIELD
MT1841376241Medicaid
ID000010138461OtherREGENCE BLUE SHIELD