1326099672 NPI number — MS. KATIE DAWN JARSTAD PA-C

Table of content: MS. KATIE DAWN JARSTAD PA-C (NPI 1326099672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326099672 NPI number — MS. KATIE DAWN JARSTAD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JARSTAD
Provider First Name:
KATIE
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLEIN
Provider Other First Name:
KATIE
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326099672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1593 E POLSTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POST FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83854-5326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-262-2300
Provider Business Mailing Address Fax Number:
208-262-2390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 W DALTON AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83815-8600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-209-2066
Provider Business Practice Location Address Fax Number:
208-209-2076
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA-580 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1326099672 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com