Provider Demographics
NPI:1982018123
Name:MEISSNER, KHRISTINA ASHLEY (DO)
Entity type:Individual
Prefix:
First Name:KHRISTINA
Middle Name:ASHLEY
Last Name:MEISSNER
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:ID
Mailing Address - Zip Code:83254-1597
Mailing Address - Country:US
Mailing Address - Phone:208-847-1630
Mailing Address - Fax:208-847-2201
Practice Address - Street 1:166 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254-4959
Practice Address - Country:US
Practice Address - Phone:208-847-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0891207Q00000X
UT14192491-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine