Individual
JESSICA JERDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6165 W EMERALD ST, BOISE, ID 83704-8613
(208) 302-3900
(208) 302-3955
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3081018
ID
363A00000X
Physician Assistant
PA224310
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500855147
—
OR
Enumeration date
03/09/2023
Last updated
06/05/2026
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