Healthcare Provider Details

I. General information

NPI: 1922200286
Provider Name (Legal Business Name): KRISTIN EDGEHOUSE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 155
COEUR D ALENE ID
83814-4462
US

IV. Provider business mailing address

PO BOX 1387
HAYDEN ID
83835-1387
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-0585
  • Fax:
Mailing address:
  • Phone: 208-415-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP60233214
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3681720
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOP60233214
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberOP60233214
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: