Active NPI
Keri Martin, PA
- Physician Assistant
- Idaho Falls, ID
National Provider Identifier
1841460508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-687
- Practice address
- 3360 Washington Parkway
Suite 2
Idaho Falls, ID 83404-2271 - Phone
- (208) 529-3967
- NPI assigned
- Mar 8, 2008
- Last updated
- Mar 21, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-687 | ID | Primary |
Addresses
Primary practice location
3360 Washington Parkway
Suite 2
Idaho Falls, ID 83404-2271
Mailing address
3360 Washington Pkwy
Suite 2
Idaho Falls, ID 83404-8332
Phone (208) 529-3967
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-687 | ID | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458518400000",
"number": "1841460508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3360 WASHINGTON PKWY",
"address_2": "SUITE 2",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834048332",
"telephone_number": "208-529-3967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3360 WASHINGTON PARKWAY",
"address_2": "SUITE 2",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834042271",
"telephone_number": "208-529-3967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KERI",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-08",
"last_updated": "2016-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA-687",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.