Kathleen Rose Nielsen, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA411 Issued in ID

Practice address

2640 S Eagle Rd
Meridian, ID 83642-6704

Phone

(208) 884-0835

Fax

(208) 884-4794

NPI assigned

May 30, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2016 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Edge Medical LLC

  • Family Medicine Physician
  • Meridian, ID
  • NPI 1922814474
  NPD Authorized official
• All Horizons Inc

  • Mental Health Counselor
  • Boise, ID
  • NPI 1285767574
  NPD (past)
• Idaho Minor Emergency and Family Practice PA

  • Clinic/Center
  • Meridian, ID
  • NPI 1205996063
  NPD (past)
• Jeffrey F Hartford MD

  • Family Medicine Physician
  • Boise, ID
  • NPI 1417151804
  NPD (past)

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1336196757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2640 S EAGLE RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426704",
            "telephone_number": "208-884-0835",
            "fax_number": "208-884-4794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 S EAGLE RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426704",
            "telephone_number": "208-884-0835",
            "fax_number": "208-884-4794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "KATHLEEN",
        "middle_name": "ROSE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-30",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO MEDICAL LICENSE",
            "identifier": "PA411",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Anne Nicolello, RDH
• Christopher Nicolet, PHARMD
• Julia Kate Niederer
• Theresa Lea Niederkruger, LCSW
• Jeffrey Nielsen, PHARMD
• Nielson Eyecare Professionals PC
• Ana D Nielson, OD
• Dennis Earl Nielson, O.D.
• Kendra Jean Nielson
• Ryan E Nielson, OD

• Physician Assistant in Meridian, ID
• Providers in Meridian, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.