Provider Demographics
NPI:1528653839
Name:DEMONEY-HENDRICKSON, KRYSTAL KAE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:KAE
Last Name:DEMONEY-HENDRICKSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W HAYS ST STE 107
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5412
Mailing Address - Country:US
Mailing Address - Phone:208-515-2812
Mailing Address - Fax:888-551-6190
Practice Address - Street 1:1015 W HAYS ST STE 107
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5412
Practice Address - Country:US
Practice Address - Phone:208-515-2812
Practice Address - Fax:888-551-6190
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID67149363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty