KELLY BEACH (NPI# 1649668765) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649668765 |
| Entity Type | Individual |
| Full Name | KELLY BEACH |
| Credential | PA |
| Practice Address |
300 W Myrtle St Suite 100 Boise ID 83702-7690 |
| Mailing Address |
Po Box 191050 Boise ID 83719-1050 |
| Practice Telephone | 2084729082 |
| Practice Fax Number | 2084729083 |
| Mailing Telephone | 2089556522 |
| Mailing Fax Number | 2089556503 |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2016-01-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA-1208 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215158746 | Kelly Mae Beach | Marriage & Family Therapist | 3652 N Rancho Dr, Ste. 102, Las Vegas, NV 89130-3178 | 2007-05-01 |
| Street Address |
300 W MYRTLE ST SUITE 100 |
| City | BOISE |
| State | ID |
| Zip Code | 83702-7690 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033329842 | April Dillion | Family Medicine | 300 W Myrtle St, Suite 100, Boise, ID 83702-7690 | 2007-05-23 |
| 1821361387 | Alliance Medical Group, LLC. | Family Medicine | 300 W Myrtle St, Boise, ID 83702-7690 | 2012-02-14 |
| 1740515287 | Rachel N. Levitch | Physician Assistant | 300 W Myrtle St, Suite 100, Boise, ID 83702-7690 | 2009-10-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
| 1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
| 1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
| 1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
| 1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
| 1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
| 1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
| 1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
| Find all providers in zip 83702 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821695792 | Chelsea Dylan Tennent | Physician Assistant | 1666 E Gentlewind St, Boise, ID 83706-5914 | 2020-10-05 |
| 1871114553 | Samantha Tess Goodrich | Physician Assistant | 721 E Lenz St, Boise, ID 83712-7846 | 2020-05-04 |
| 1689131005 | Aftin Jade Martens | Physician Assistant | 303 N Allumbaugh St, Boise, ID 83704-9208 | 2019-02-21 |
| 1215418140 | Michael Edward Molnar | Physician Assistant | 2012 S Longmont Ave, Boise, ID 83706-4235 | 2018-08-28 |
| 1578059143 | Mckenzie Hart | Physician Assistant | 4334 S Aleut Way, Boise, ID 83709-6033 | 2018-07-07 |
| 1174035638 | Zacharia Njoroge | Physician Assistant | 1055 N Curtis Rd 6th Floor, Boise, ID 83706 | 2017-10-24 |
| 1073040242 | Nicole Ankenbrandt | Physician Assistant | 3151 S Terra Dr, Boise, ID 83709-3831 | 2017-05-17 |
| 1346792033 | Samantha Rae Lange | Physician Assistant | 1072 N Liberty St Ste 203, Boise, ID 83704 | 2016-10-27 |
| 1174070098 | Alexandra W Clapp | Physician Assistant | 6140 West Curtisian Avenue Suite 200, Boise, ID 83704 | 2016-09-08 |
| 1376914838 | Morgan Grace Roskelley | Physician Assistant | 703 S. Americana Blvd, Ste 120, Boise, ID 83702 | 2015-10-09 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.