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

Kelly Jo Vincent, PA-C

Individual provider Physician Assistant · NPI 1194190637

Kelly Jo Vincent, PA-C is a Physician Assistant in Boise, Idaho. Qualified in 2015, 11 years ago. Practices with Tadje Orthopaedics LLC, a 3-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
11
Licensed in
ID
In the registry since
2015
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

8854 W Emerald St Ste #102
Boise, ID 83704-4844
Phone: (208) 323-4747
Fax: (208) 323-4848
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3399 E Louise Dr Ste 200, Meridian, ID 83642-5212 — (208) 706-2663

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-1332 (ID)

Record details

NPI number1194190637
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedDecember 9, 2015
Last updated in NPPESApril 19, 2023
Certification dateApril 19, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Tadje Orthopaedics Llc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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