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General NPI Number Information
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NPI Number | 1922513886
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Entity Type | Individual
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Provider Name | KRISTIE GLEN KARROUM FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3320 S 25TH E
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4606
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Country | US
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Telephone | 208-569-9031
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Fax |
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Provider Business Mailing Address
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Address Line | 5480 GLENEAGLES DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-6315
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Country | US
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Telephone | 208-569-9031
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 57631
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | PENDING
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License Number State | ID
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