Healthcare Provider Details

I. General information

NPI: 1558265520
Provider Name (Legal Business Name): KADEN PATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 E CENTRAL DR
MERIDIAN ID
83642-7991
US

IV. Provider business mailing address

2700 E OVERLAND RD APT F110
MERIDIAN ID
83642-8969
US

V. Phone/Fax

Practice location:
  • Phone: 208-282-3508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: