Kelly Marie Landle, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-345 Issued in ID

Practice address

606 E Main St
Kendrick, ID 83537

Phone

(208) 289-3841

Fax

(208) 289-3961

NPI assigned

Mar 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Public Hospital District No 3 of Whitman County

  • Critical Access Hospital
  • Colfax, WA
  • NPI 1922009448
  NPD (past)

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555372800000",
    "number": "1497723217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S MAIN ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838433046",
            "telephone_number": "208-882-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 E MAIN ST",
            "city": "KENDRICK",
            "state": "ID",
            "postal_code": "83537",
            "telephone_number": "208-289-3841",
            "fax_number": "208-289-3961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 Warner Dr",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ID",
            "postal_code": "835014441",
            "country_code": "US",
            "telephone_number": "208-743-3523",
            "fax_number": "208-746-8741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANDLE",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2019-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-345",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10004069",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004069",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806673600",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970027265",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE WORK COMP",
            "identifier": "0141613",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8201634",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jeffrey F Sowle, DDS

• All providers in Kendrick, ID
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; 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.