Individual
JACOB WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
382 N OVERLAND AVE, BURLEY, ID 83318-3433
(208) 678-6996
(208) 678-6866
Mailing address
738 MONROE ST, TWIN FALLS, ID 83301-3857
(208) 404-2333
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-1452
ID
Other
Enumeration date
11/09/2016
Last updated
11/09/2016
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