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

Kelly Anderson

Individual provider Physician Assistant · NPI 1295465284

Kelly Anderson is a Physician Assistant in Boise, Idaho. Qualified in 2022, 4 years ago. Practices with Saint Alphonsus Regional Medical Center Inc, a 673-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
4
Licensed in
ID
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

6051 W Emerald St
Boise, ID 83704-8969
Phone: (208) 302-5150
Fax: (208) 302-5155
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2506 1/2 N Heights Dr, Boise, ID 83702-2836 — (813) 415-9645

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-2336 (ID)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1295465284
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJune 13, 2022
Last updated in NPPESOctober 28, 2022
Certification dateOctober 28, 2022
Mailing address3340 E Goldstone Dr, Meridian, ID 83642-1026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Saint Alphonsus Regional Medical Center Inc — 673 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations11 on file with Medicare

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