Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
ARIEL SHANTAY AVIS TAYSOM, PA-C
Active Sole ProprietorARIEL SHANTAY AVIS TAYSOM, PA-C is a Physician Assistant healthcare provider located in MALAD CITY, Idaho. NPI 1609341098 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · MALAD CITY, ID
Registration Details
- NPI Number
- 1609341098
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Oct 11, 2018 (7.8322680885481 yrs)
- Last Updated
- Nov 16, 2021
- License
-
PA-1656 (ID)
- Sole Proprietor
- Yes
Practice Information
- Address
-
220 BANNOCK STMALAD CITY, ID, 832525068Browse ID providers · Browse ZIP 83252
- Phone
- 2087662600
- Fax
- 2087664258
- Primary Specialty
-
Physician Assistant
363A00000X
Other Physician Assistant Providers in MALAD CITY, ID
| Name | Credential | NPI |
|---|---|---|
| RICK C. CLARK JR. | PA | 1033190533 |
| ROBERT TODD GILLESPIE | P.A. | 1922026467 |
| MEL BINGHAM | PA-C | 1134257876 |
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.