Katee Jo Rodriguez, PA-C
Individual provider Active NPI Physician Assistant · Payette, ID
NPI 1306197140 · NPPES record last updated Sep 19, 2012
Key facts
- NPI
- 1306197140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 00000 (ID)
- Practice address
- 1441 NE 10TH Ave
Payette, ID 83661-5420 - Phone
- (208) 642-9376
- Fax
- (208) 642-9598
- NPI assigned
- Sep 19, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00000 | ID | MD | Certified Registered Nurse Anesthetist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 00000 | ID | Yes |
Addresses
Primary practice location
1441 NE 10TH Ave
Payette, ID 83661-5420
Mailing address
1441 NE 10TH Ave
Payette, ID 83661-5420
Phone (208) 642-9376
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Other | ID | IDAHO LICENSE PENDING |
Other names
- Katee Jo Brewer
Other providers in Payette, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.