Kyrstanne Kaye Idom, PA

NPI #1659248953 in Grantsville, Utah

Provider Information

NPI Number: 1659248953
Entity Type: Individual
Name: Kyrstanne Kaye Idom, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Oct 21, 2025
Last Updated: Oct 21, 2025

Practice Location

Address: 228 S TAWNY DR
City: Grantsville
State: Utah
ZIP Code: 84029-5028
Phone: (801) 580-9139

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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