MEDICARE: EMILY KATHERINE OE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1831877869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY KATHERINE OE PA

Provider Business Mailing Address
First Line	:	2550 W BARBERRY LN
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-5655
Country	:	US
Telephone Number	:	208-521-4704
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 W BARBERRY LN
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-5655
Country	:	US
Telephone Number	:	208-521-4704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	08/08/2025

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Directions to “ EMILY KATHERINE OE PA” Practice Location

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