Kimberley D Blewett, D.O.
Individual provider Active NPI Family Medicine Physician · Moscow, ID
NPI 1306038997 · NPPES record last updated Nov 17, 2011
Key facts
- NPI
- 1306038997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 66740581204 (UT)
- Practice address
- 623 South Main Street
Moscow, ID 83843 - Phone
- (208) 882-2011
- Fax
- (208) 883-1853
- NPI assigned
- Aug 16, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170511001190 | WA | Practitioner - Emergency Medicine |
4688768831 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66740581204 | UT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-State Memorial Hospital | Family Medicine | Current | Accepting new patients |
| Tri-State Memorial Hospital | Family Medicine | Current |
Accepting new patients |
| Tri-State Memorial Hospital | Family Medicine | Current |
Accepting new patients |
Locations
1221 Highland Ave
Clarkston, WA 99403
Phone (509) 751-0312
1267 Belmont Way
Clarkston, WA 99403
Phone (509) 751-1500
Interoperability endpoints
- kimberley.blewett@tsmh.medicity.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 66740581204 | UT | Yes |
Addresses
Primary practice location
623 South Main Street
Moscow, ID 83843
Mailing address
623 South Main Street
Moscow, ID 83843
Phone (208) 882-2011
Other names
- Kimberley Dawn Cattron
Other providers in Moscow, ID
- Better Psych, LLC
- Erin Bierstedt
- Madison Nicole Bittle
- BK Inc.
- Erik Blaker
- Bloomin Family Therapy, LLC
- Bluesky Dental
- Elizabeth Bonanni
- Morgan E Bond
- Jessica E Bonnett
All providers in Moscow, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.