Provider Demographics
NPI:1326099672
Name:JARSTAD, KATIE DAWN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:DAWN
Last Name:JARSTAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:DAWN
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1593 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5326
Mailing Address - Country:US
Mailing Address - Phone:208-262-2300
Mailing Address - Fax:208-262-2390
Practice Address - Street 1:315 W DALTON AVE STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8600
Practice Address - Country:US
Practice Address - Phone:208-209-2066
Practice Address - Fax:208-209-2076
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-580363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1326099672Medicaid
IDP00411668OtherRAILROAD MEDICARE
ID1185830001OtherMEDICARE DMERC
IDQ58777Medicare UPIN
ID1185830001OtherMEDICARE DMERC