Krista Marie Kelly, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

90 Hope Dr
Mountain Home Afb, ID 83648-1057

Phone

(208) 828-7505

NPI assigned

Apr 20, 2021

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745798400000",
    "number": "1477134443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 HOPE DR BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481062",
            "telephone_number": "208-828-6806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HOPE DR",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481057",
            "telephone_number": "208-828-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KRISTA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-20",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1204799",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Murphy Huffaker, DDS
• Sydnie Lysette Huschle-Renk
• Tyler Jewkes, PHARMD
• Ryan D Kainrath, IDMT
• Jakob Kamilow
• Kristin Kepler, RN, DNP, WHNP-BC
• Kellie King, CSW-INTERN
• Casey Elizabeth Lynch, WHNP-BC
• Thomas Madden
• Andrew James Magyan, DO

• Medical Physician Assistant in Mountain Home Afb, ID
• Providers in Mountain Home Afb, 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 Apr 28, 2025; 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.