Healthcare Provider Details

I. General information

NPI: 1174314306
Provider Name (Legal Business Name): KATELYN BRIMHALL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 IDAHO ST
LEWISTON ID
83501-1940
US

IV. Provider business mailing address

731 N IRON BRIDGE WAY
SPOKANE WA
99202-4926
US

V. Phone/Fax

Practice location:
  • Phone: 208-848-8300
  • Fax: 509-434-0392
Mailing address:
  • Phone: 509-444-8888
  • Fax: 509-444-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: