Provider Demographics
NPI:1528302833
Name:ENOS, KASSIE E (PA-C)
Entity type:Individual
Prefix:MS
First Name:KASSIE
Middle Name:E
Last Name:ENOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-367-3131
Mailing Address - Fax:208-367-3174
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-367-3131
Practice Address - Fax:208-367-3174
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMAO55875363AM0700X
IDPA-1608363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical