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General NPI Number Information
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NPI Number | 1235023664
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Entity Type | Individual
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Provider Name | ANDRINA KALITA PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2265 W BROADWAY ST
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City | IDAHO FALLS
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State | ID
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Zip | 83402-2996
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Country | US
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Telephone | 208-524-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 3810 NATHAN DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7952
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Country | US
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Telephone | 360-216-5428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4371464
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License Number State | ID
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