Mary Lynn James, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA153580 Issued in OR

Practice address

1100 NW 12TH St
Fruitland, ID 83619-5040

Phone

(208) 452-6556

Fax

(541) 216-6557

NPI assigned

Dec 15, 2010

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 names 1

• Mary Lynn Stredder Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Snake River Pediatrics, PC

  • Rural Health Clinic/Center
  • Fruitland, ID
  • NPI 1720489396
  NPD (past)

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

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1982907747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 NW 12TH ST",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836195040",
            "telephone_number": "208-452-6556",
            "fax_number": "541-216-6557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 NW 12TH ST",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836195040",
            "telephone_number": "208-452-6556",
            "fax_number": "541-216-6557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAMES",
        "first_name": "MARY",
        "middle_name": "LYNN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-15",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA153580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "STREDDER",
            "middle_name": "LYNN",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Issc Fruitland
• Iwasa Eye Center P.a.
• J Alan Timmons DDS PC
• Erin Doraine Jackson, PHARMD, CDM
• Sheila Diane Jacobs, MPT
• Jangula Cox Counseling LLC
• JC2 Enterprises LLC
• Trenton John Jenks, PHARM. D, CGP
• Michael Jeppesen, DPT
• Brett Johansen, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; 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.