Kylee Shaw, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

1411 Falls Ave E Ste 1002
Twin Falls, ID 83301-3459

Phone

(208) 595-5424

NPI assigned

Aug 16, 2018

Last updated

Aug 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Idaho Skin Institute LLCGroup PAC ID 0648658807, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: kylees@idahoskin.emadirect.md

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.

• Idaho Skin Institute LLC

  • Dermatology Physician
  • Chubbuck, ID
  • NPI 1184375867
  Medicare reassignment Care Compare group
• Douglas a. Thomas, MD

  dba Thomas Dermatology

  • Dermatology Physician
  • Las Vegas, NV
  • NPI 1891897658
  NPD (past)

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

{
    "created_epoch": "1534377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1225518509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 W CHUBBUCK RD",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832022314",
            "telephone_number": "208-238-7546",
            "fax_number": "208-237-9643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 FALLS AVE E STE 1002",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013459",
            "telephone_number": "208-595-5424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "895 Adams Blvd",
            "address_purpose": "LOCATION",
            "city": "Boulder City",
            "state": "NV",
            "postal_code": "890052235",
            "country_code": "US",
            "telephone_number": "702-293-0406",
            "fax_number": "702-293-0192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KYLEE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-16",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serenidad Psychology LLC
• Mendizje Serpa
• SH1 Midstate MGMT LLC
• Heather Shaw
• Kory Lynn Shaw, OD
• Michael Shaw, DO
• Samuel Teagan Shaw, FNP-C
• Thomas Domingo Shaw, P.T.
• Stephanie Ann Shawver, AGACNP-BC
• Idris Jamal Shelby

• Medical Physician Assistant in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.