Kelly Marie Landle, PA-C is a
Physician Assistant based in Kendrick, Idaho. Kelly Marie Landle is licensed to practice in Idaho (license number PA-345) and her current practice location is
606 E Main St, Kendrick, Idaho. She can be reached at her office (for appointments etc.) via phone at
(208) 289-3841.
NPI number for Kelly Marie Landle is 1497723217 and her current mailing address is 700 S Main St, Moscow, Idaho. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1497723217.
Provider's Profile
| Full Name | Kelly Marie Landle |
|---|
| Gender | Female |
|---|
| Speciality | Physician Assistant |
|---|
| Location | 606 E Main St, Kendrick, Idaho |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1497723217
- Provider Enumeration Date: 03/08/2006
- Last Update Date: 04/16/2019
Medical Identifiers
Medical identifiers for Kelly Marie Landle such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1497723217 | NPI | - | NPPES |
| 806673600 | Medicaid | ID | |
| 970027265 | Other | | RAILROAD MEDICARE |
| 0141613 | Other | WA | STATE WORK COMP |
| 8201634 | Medicaid | WA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | PA-345 (Idaho) | Primary |
| 363AS0400X | Physician Assistant - Surgical | PA10004069 (Washington) | Secondary |
| 363AM0700X | Physician Assistant - Medical | PA10004069 (Washington) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Marie Landle is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kelly Marie Landle, PA-C
700 S Main St,
Moscow, ID 83843-3046
Ph: (208) 882-4511 | Kelly Marie Landle, PA-C
606 E Main St,
Kendrick, ID 83537
Ph: (208) 289-3841 |
Reviews and Comments