KRYSTLE CLARK (NPI# 1083994586) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083994586 |
| Entity Type | Individual |
| Full Name | KRYSTLE CLARK |
| Practice Address |
3212 E Chinden Blvd Eagle ID 83616-6473 |
| Practice Telephone | 2083190538 |
| Mailing Telephone | 2083190538 |
| Enumeration Date | 2011-08-28 |
| Last Update Date | 2011-08-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | P6315 | ID | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255948527 | Krystle Diane Clark | Behavior Technician | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904-4559 | 2020-09-30 |
| Street Address |
3212 E CHINDEN BLVD |
| City | EAGLE |
| State | ID |
| Zip Code | 83616-6473 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528342623 | James Robert Frisk | Pharmacist | 3212 E Chinden Blvd, Eagle, ID 83616-6473 | 2011-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730714049 | Care Medical Housecalls PC | Nurse Practitioner | 2040 E Holgate Ct, Eagle, ID 83616 | 2020-03-06 |
| 1629613823 | Counseling Solutions Center LLC | Marriage & Family Therapist | 2618 East Snocreek, Eagle, ID 83616 | 2019-11-12 |
| 1245726918 | Tracy Lyn Hagadorn | Midwife | 182 State Street, Eagle, ID 83616 | 2018-07-06 |
| 1861922627 | Nicholas A. Stelzner | Counselor | 2419 W. State St. Suite 8, Boise, ID 83616 | 2017-06-14 |
| 1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
| 1376940668 | Cecilia Jo Hickam | Dental Hygienist | 1121 E. State Street, Suite - 102-d, Eagle, ID 83616 | 2014-12-02 |
| 1871912634 | Christine E Birch | Psychiatry & Neurology | 1032 S Bridgeway Pl Ste 110, Eagle, ID 83616 | 2014-04-09 |
| 1043552524 | Tori Croshaw | Social Worker | 372 S Eagle Rd Ste 190, Eagle, ID 83616 | 2013-03-21 |
| 1053650010 | Kellie Ann Northam | Nurse Practitioner | 192 West State Street, Eagle, ID 83616 | 2013-02-11 |
| 1437494457 | Mary Beth Roehling | Nurse Practitioner | 2040 E Hologate Ct, Eagle, ID 83616 | 2012-12-03 |
| Find all providers in zip 83616 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477186542 | Mark David Johnston | Pharmacist | 1683 E Myrtle Beach Ct, Eagle, ID 83616-5366 | 2020-02-18 |
| 1689213829 | Erin E Johnson | Pharmacist | 0103 Market Street, Eagle, CO 81631 | 2020-01-06 |
| 1437795259 | Paul Charles Villaret | Pharmacist | 1855 N Groveland Pl, Eagle, ID 83616-4275 | 2019-11-27 |
| 1780125252 | Brendan Quinn | Pharmacist | 264 Fulford Drive, Eagle, CO 81631 | 2017-03-16 |
| 1326399627 | Alex Servatius | Pharmacist | 217 N Storybook Way, Eagle, ID 83616-4891 | 2012-09-26 |
| 1043507163 | Shannon Kay Halpin | Pharmacist | 2081 W Preston St, Eagle, ID 83616-6907 | 2011-07-10 |
| 1801089339 | Julie Eisele | Pharmacist | 1348 W Stafford Dr, Eagle, ID 83616-6487 | 2007-08-17 |
| 1639380074 | Thomas P Hamilton | Pharmacist | 774 W Aikens Ct, Eagle, ID 83616-4952 | 2007-05-25 |
| 1851900518 | Kailyn Kyrine Christensen | Pharmacist | 250 S Eagle Rd, Eagle, ID 83616-5906 | 2020-07-29 |
| 1447710728 | Alyssa Renae Zibrowski | Pharmacist | 149 W State St Ste 101, Eagle, ID 83616-4911 | 2019-03-22 |
| Find all providers in EAGLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.