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

Shelby Lidstrom

Individual provider Physician Assistant · NPI 1154722155

Shelby Lidstrom is a Physician Assistant in Monroe, Washington. Qualified in 2007, 19 years ago. Practices with Kootenai Health Inc, a 394-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho and Washington.

Years since qualifying
19
Licensed in
ID, WA
In the registry since
2014
Specialties on file
2
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Practice location Address checks out

19200 N Kelsey St
Monroe, WA 98272-1431
Phone: (360) 794-7994
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1919 Lincoln Way Ste 315, Coeur D Alene, ID 83814-2527 — (208) 625-6000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA60463924 (WA)
Physician Assistant Taxonomy 363A00000X · Licence PA-2541 (ID)

Record details

NPI number1154722155
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 9, 2014
Last updated in NPPESJuly 24, 2025
Certification dateJuly 24, 2025
Mailing addressPo Box 3360, Portland, OR 97208-3360

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Kootenai Health Inc — 394 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Monroe