Provider Demographics
NPI:1457363970
Name:COLSON, KATHRYN A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:A
Last Name:COLSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8854 W EMERALD ST
Mailing Address - Street 2:STE 102
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4844
Mailing Address - Country:US
Mailing Address - Phone:208-323-4747
Mailing Address - Fax:208-323-4848
Practice Address - Street 1:8854 W EMERALD ST
Practice Address - Street 2:STE 102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4844
Practice Address - Country:US
Practice Address - Phone:208-323-4747
Practice Address - Fax:208-323-4848
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-102363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID4546260001Medicaid
IDR34069Medicare UPIN
ID1665012Medicare ID - Type Unspecified