Healthcare Provider Details

I. General information

NPI: 1417261934
Provider Name (Legal Business Name): KYRSTEN E STOOPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 S MAIN ST STE 1
MOSCOW ID
83843
US

IV. Provider business mailing address

PO BOX 8007
MOSCOW ID
83843-0507
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-2011
  • Fax: 208-883-1853
Mailing address:
  • Phone: 208-883-2224
  • Fax: 208-883-6580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-12207
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.60298970
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: