Healthcare Provider Details

I. General information

NPI: 1982018123
Provider Name (Legal Business Name): KHRISTINA ASHLEY MEISSNER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 S 5TH ST
MONTPELIER ID
83254-4959
US

IV. Provider business mailing address

164 S 5TH ST
MONTPELIER ID
83254-1597
US

V. Phone/Fax

Practice location:
  • Phone: 208-847-1110
  • Fax:
Mailing address:
  • Phone: 208-847-1630
  • Fax: 208-847-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-0891
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14192491-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: