Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
LYLE JEREMY JACKSON, CRNA
Active Sole ProprietorLYLE JEREMY JACKSON, CRNA is a Orthopedic Nurse healthcare provider located in IDAHO FALLS, Idaho. NPI 1225597305 is currently active in the NPPES registry. Verify at CMS.
Orthopedic Nurse · IDAHO FALLS, ID
Registration Details
- NPI Number
- 1225597305
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Mar 18, 2019 (7.2248003472458 yrs)
- Last Updated
- Jun 30, 2025
- Licenses
-
125895 (VA)D183481 (IA)62439 (ID)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2325 CORONADO STIDAHO FALLS, ID, 834047407Browse ID providers · Browse ZIP 83404
- Phone
- 2085572700
- Primary Specialty
-
Orthopedic Nurse
163WX0800X
- Additional Specialty
- Certified Nurse Anesthetist (CRNA)
- Additional Specialty
- Orthopedic Nurse
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.