Krysta Nicole Carlson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5081403 Issued in ID

Practice address

108 E Idaho Ave
Homedale, ID 83628-5003

Phone

(208) 337-3189

Fax

(208) 466-5359

NPI assigned

Jul 27, 2014

Last updated

Jun 5, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clinicas del Camino Real IncGroup PAC ID 3173434396, 99 clinicians

Community Health Clinics IncGroup PAC ID 4082527353, shared by 17 NPIs, 75 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Simi Valley Hospital, Simi Valley, CA, CCN 050236

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kcarlson802596@direct.ochin.org
• Direct secure messaging: krysta.carlson.p1@direct.clinicas.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clinicas del Camino Real Inc

  dba Clinicas del Camino Real, Inc., Ventura

  • Federally Qualified Health Center (FQHC)
  • Ventura, CA
  • NPI 1679631907
  Medicare reassignment Care Compare group
• Clinicas del Camino Real Inc

  dba Clinicas del Camino Real, Inc., La Colonia

  • Federally Qualified Health Center (FQHC)
  • Oxnard, CA
  • NPI 1942789359
  NPD
• Clinicas del Camino Real Inc

  dba Clinicas del Camino Real, Inc., Paseo Camarillo

  • Federally Qualified Health Center (FQHC)
  • Camarillo, CA
  • NPI 1295297190
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Simi Valley Hospital and Health Care Services

  • General Acute Care Hospital
  • Simi Valley, CA
  • NPI 1063495190
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780617600000",
    "number": "1740698356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836530009",
            "telephone_number": "208-467-4431",
            "fax_number": "208-467-7684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 E IDAHO AVE",
            "city": "HOMEDALE",
            "state": "ID",
            "postal_code": "836285003",
            "telephone_number": "208-337-3189",
            "fax_number": "208-466-5359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Newbury Rd",
            "address_purpose": "LOCATION",
            "city": "Newbury Park",
            "state": "CA",
            "postal_code": "913206435",
            "country_code": "US",
            "telephone_number": "805-498-3640",
            "fax_number": "805-498-3641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "KRYSTA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-27",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA51782",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "5081403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Health Clinics, Inc. (Terry Reilly Health Services)
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• Community Health Clinics, Inc. (Terry Reilly Health Services)
• Jesse Tyler Cook, DPT

• Physician Assistant in Homedale, ID
• Providers in Homedale, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.