Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Katie Diane Maddock

Individual provider Physician Assistant · NPI 1275261059

Katie Diane Maddock is a Physician Assistant in Idaho Falls, Idaho. Qualified in 2024, 2 years ago. Practices with Leavitt Womens Healthcare Corp PC, a 7-clinician group and accepts Medicare assignment.

Years since qualifying
2
In the registry since
2022
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1550 Elk Creek Dr
Idaho Falls, ID 83404-8322
Phone: (208) 529-5942
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1275261059
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 10, 2022
Last updated in NPPESNovember 23, 2024
Certification dateNovember 23, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Leavitt Womens Healthcare Corp.Pc — 7 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Idaho Falls