Individual provider Active NPI

Kimberly Rose Mrozek, PA-C

  • Medical Physician Assistant
  • Boise, ID
National Provider Identifier
1164985867
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
3271156 Issued in ID
Practice address
190 E Bannock St FL 10
Boise, ID 83712-6241
Phone
(208) 381-5500
Fax
(208) 381-2555
NPI assigned
Apr 9, 2019
Last updated
Jul 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2816 KY
Medical Physician Assistant 363AM0700X 4845 WI
Medical Physician Assistant 363AM0700X TC074 KY
Medical Physician Assistant 363AM0700X 3271156 ID Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

190 E Bannock St FL 10
Boise, ID 83712-6241

Mailing address

190 E Bannock St
Boise, ID 83712-6241

Other practice location 1

1836 South Ave
LA Crosse, WI 54601-5429
Phone (608) 782-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, KY, IN, ID4 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 4

Enrollment IDStateProvider typePAC IDDetails
I20201029000639 WI Practitioner - Physician Assistant 0345570164 Reassigns benefits to 3 organizations
I20210908001380 KY Practitioner - Physician Assistant 0345570164 Reassigns benefits to 2 organizations
I20220324001275 IN Practitioner - Physician Assistant 0345570164 Reassigns benefits to 2 organizations
I20250923003075 ID Practitioner - Physician Assistant 0345570164 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

100 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2983

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-9384

222 N 2ND St
Boise, ID 83702-6130

520 S Eagle Rd
Meridian, ID 83642-6355

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA2816KYMDPhysician Assistant
3271156IDMDMedical Physician Assistant
TC074KYMDMedical Physician Assistant
4845WIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Express Care, Inc CurrentSince Sep 14, 2020 Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Sep 14, 2020 Accepting new patients
Gundersen Lutheran Medical Center Inc CurrentSince Sep 14, 2020 Accepting new patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Jul 21, 2025 Accepting new patients
Baptist Health Medical Group Inc Physician Assistant CurrentSince Oct 1, 2024 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Sep 14, 2020 Accepting new patients
Gundersen Clinic LTD CurrentSince Sep 14, 2020 Accepting new patients
St Lukes Regional Medical Center PastSince Aug 17, 2025 Accepting new patients
Gundersen Clinic LTD Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

190 E Bannock St
Fl 10
Boise, ID 83712
Phone (208) 381-5500

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681

610 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 326-6466

18601 Lincoln St
Whitehall, WI 54773
Phone (715) 538-1712

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753056000000",
    "number": "1164985867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST FL 10",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-5500",
            "fax_number": "208-381-2555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1836 South Ave",
            "address_purpose": "LOCATION",
            "city": "LA Crosse",
            "state": "WI",
            "postal_code": "546015429",
            "country_code": "US",
            "telephone_number": "608-782-7300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MROZEK",
        "first_name": "KIMBERLY",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-09",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2816",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "4845",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "TC074",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "3271156",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.