Healthcare Provider Details

I. General information

NPI: 1366453524
Provider Name (Legal Business Name): KRISTYN A SCHELHAAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTYN AXTMAN

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 N HAPPY VALLEY RD
NAMPA ID
83687-5280
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-809-2869
  • Fax: 208-809-2861
Mailing address:
  • Phone: 208-955-6500
  • Fax: 208-955-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7928
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0-0528
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: