NPIMap

Individual provider Active NPI

Katie Elizabeth Van Lier, PA-C

  • Physician Assistant
  • Boise, ID
National Provider Identifier
1801132980
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-2034 Issued in ID
Practice address
10255 W Overland Rd
Boise, ID 83709-1430
Phone
(208) 302-5600
Fax
(208) 302-5655
NPI assigned
Dec 18, 2012
Last updated
May 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA08089 TX
Physician Assistant 363A00000X PA-2034 ID Primary

Addresses

Primary practice location

10255 W Overland Rd
Boise, ID 83709-1430

Mailing address

3340 E Goldstone Dr
Meridian, ID 83642-1026
Phone (208) 367-5170

Other practice location 1

7121 Spid Dr
#102
Corpus Christi, TX 78412-4938
Phone (361) 993-3456

Other practice location 2

701 E Parkcenter Blvd
Boise, ID 83706-6528
Phone (208) 381-6500

Other names 1

  • Miss Katie E Gibbons Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230208000252 ID Practitioner - Physician Assistant 5092960443 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Keystone Center for Geriatrics LLCGroup PAC ID 7618365792, 8 clinicians

Practice addresses (Care Compare)

1139 E Winding Creek Dr
Eagle, ID 83616-7232
Phone (208) 963-1034

305 W Bannock St
Boise, ID 83702-6033
Phone (208) 514-0670

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince May 15, 2023 Accepting new patients
Thomas-Spann Clinic, P.a. Past Accepting new patients
Marion Luque,PLLC PastSince May 1, 2004 Accepting new patients
Key Stone Health Care Past Accepting new patients

Locations

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

701 E Parkcenter Blvd
Boise, ID 83706
Phone (208) 381-6400

Organizations & group practices 5

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

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1355788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1801132980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10255 W OVERLAND RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091430",
            "telephone_number": "208-302-5600",
            "fax_number": "208-302-5655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7121 Spid Dr",
            "address_2": "#102",
            "address_purpose": "LOCATION",
            "city": "Corpus Christi",
            "state": "TX",
            "postal_code": "784124938",
            "country_code": "US",
            "telephone_number": "361-993-3456",
            "fax_number": "361-992-4120",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 E Parkcenter Blvd",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837066528",
            "country_code": "US",
            "telephone_number": "208-381-6500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN LIER",
        "first_name": "KATIE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-18",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA08089",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "GIBBONS",
            "middle_name": "E",
            "prefix": "MISS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.