Healthcare Provider Details

I. General information

NPI: 1356978100
Provider Name (Legal Business Name): KYRA NICOLE MCCOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 130
COEUR D ALENE ID
83814-4404
US

IV. Provider business mailing address

1204 N VERCLER RD
SPOKANE VALLEY WA
99216-1020
US

V. Phone/Fax

Practice location:
  • Phone: 208-754-3100
  • Fax: 208-754-3190
Mailing address:
  • Phone: 509-228-1000
  • Fax: 509-252-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number61631519
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2571647
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: