# KELLY MARIE LANDLE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1497723217
- **Gender:** F
- **Credential:** P.A.-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA-345 | ID | Yes |
| 363AM0700X | Medical Physician Assistant | PA10004069 | WA | — |
| 363AS0400X | Surgical Physician Assistant | PA10004069 | WA | — |

## Other

- **Enumeration date:** 03/08/2006
- **Last updated:** 04/16/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0141613 | STATE WORK COMP | WA |
| 05 | — | 806673600 | — | ID |
| 05 | — | 8201634 | — | WA |
| 01 | — | 970027265 | RAILROAD MEDICARE | — |