Provider Demographics
NPI:1134720196
Name:REIDY, KATE ELIZABETH (FNP-C)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:ELIZABETH
Last Name:REIDY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 W TANAGER AVE
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8855
Mailing Address - Country:US
Mailing Address - Phone:509-999-0100
Mailing Address - Fax:
Practice Address - Street 1:16760 N HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-8715
Practice Address - Country:US
Practice Address - Phone:208-620-5250
Practice Address - Fax:844-807-3782
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID66278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily