Healthcare Provider Details

I. General information

NPI: 1104761824
Provider Name (Legal Business Name): KRISTY L EASTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9321 N GOVERNMENT WAY STE E
HAYDEN ID
83835-8263
US

IV. Provider business mailing address

9321 N GOVERNMENT WAY STE E
HAYDEN ID
83835-8263
US

V. Phone/Fax

Practice location:
  • Phone: 208-664-0165
  • Fax: 208-664-5695
Mailing address:
  • Phone: 208-664-0165
  • Fax: 208-664-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1581609
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: