TATE STAKER, PA-C

Physician Assistant

Active Individual
NPI: 1184253585

Practice Address

130 W MAIN ST
Rexburg, ID 83440

Phone: (208) 356-8818

Specialties

Specialty Code Primary License
Student in an Organized Health Care Education/Training Program 390200000X No -
Physician Assistant 363A00000X Yes PA-1932 (ID)

Frequently Asked Questions

NPI 1184253585 is the National Provider Identifier for TATE STAKER, PA-C, a Physician Assistant provider located in Rexburg, ID. This NPI was enumerated on April 7, 2020.
TATE STAKER, PA-C practices at 130 W MAIN ST, Rexburg, ID 83440.

Quick Facts

NPI
1184253585
Type
Individual
Enumerated
Apr 7, 2020
Last Updated
Oct 28, 2021

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