Krysta Nicole Carlson, PA-C
Individual provider Active NPI Physician Assistant · Homedale, ID
NPI 1740698356 · NPPES record last updated Jun 5, 2026
Key facts
- NPI
- 1740698356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5081403 (ID)
- Practice address
- 108 E Idaho Ave
Homedale, ID 83628-5003 - Phone
- (208) 337-3189
- Fax
- (208) 466-5359
- NPI assigned
- Jul 27, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 33
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Clinicas del Camino Real Inc
Community Health Clinics Inc
Practice addresses (Care Compare)
1000 Newbury Rd
Suite 150
Newbury Park, CA 91320-6438
Phone (805) 498-3640
108 E Idaho Ave
Homedale, ID 83628-3229
Phone (208) 337-3189
150 2ND St
Melba, ID 83641-5199
Phone (208) 495-1011
207 1St St S
Nampa, ID 83651-3703
Phone (208) 466-7869
500 E Main St
Santa Paula, CA 93060-2607
Phone (805) 933-0895
Hospital & facility affiliations
- Adventist Health Simi Valley
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180323001118 | CA | Practitioner - Physician Assistant | 0244592657 | Reassigns benefits to 1 organization |
| I20260619001861 | ID | Practitioner - Physician Assistant | 0244592657 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5081403 | ID | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinicas del Camino Real Inc | Current |
Accepting new patients | |
| Clinicas del Camino Real Inc | Past | Accepting new patients |
Locations
500 E Main St
Santa Paula, CA 93060
Phone (805) 933-0895
Interoperability endpoints
- krysta.carlson.p1@direct.clinicas.nextgenshare.com
- kcarlson802596@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA51782 | CA | |
| Physician Assistant | 363A00000X | 5081403 | ID | Yes |
Addresses
Primary practice location
108 E Idaho Ave
Homedale, ID 83628-5003
Mailing address
PO Box 9
Nampa, ID 83653-0009
Phone (208) 467-4431
Other practice location 1
1000 Newbury Rd
Newbury Park, CA 91320-6435
Phone (805) 498-3640
Other providers in Homedale, ID
- A & a a Special Touch Home Care Inc
- Advanced Behavioral Solutions, LLC
- Albertsons LLC
- Kerby Andersen
- Davis Madsen Borg
- Community Health Clinics, Inc.
- Community Health Clinics, Inc.
- Community Health Clinics, Inc.
- Community Health Clinics, Inc.
- Jesse Tyler Cook
All providers in Homedale, ID · Physician Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.