Tesslyn Suzanne Keim, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1878 Issued in ID

Practice address

8854 W Emerald St Ste 140
Boise, ID 83704-4845

Phone

(208) 321-4790

Fax

(503) 963-2802

NPI assigned

Nov 12, 2012

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1352678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594684800000",
    "number": "1376887547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 NE 19TH AVE",
            "address_2": "SUITE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322684",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST STE 140",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044845",
            "telephone_number": "208-321-4790",
            "fax_number": "503-963-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEIM",
        "first_name": "TESSLYN",
        "middle_name": "SUZANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-12",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2047400",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500667246",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela M Kehlenbrink, PA
• Ethan Isaac Keierleber
• Michael V Keiley, MD
• Teo Keilwitz
• Annie Marie Keim, LPC
• Jordan Kell, PHARMACY INTERN
• Valerie Lynn Kellbach Barizo, DDS
• Hayley Rose Keller, MS
• Terry Keller
• Christopher Kelley

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.