Individual
TARA POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2730 CHANNING WAY, IDAHO FALLS, ID 83404-5049
(208) 542-7100
(208) 542-7150
Mailing address
2730 CHANNING WAY, IDAHO FALLS, ID 83404-5049
(208) 542-7100
(208) 542-7150
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-1198
ID
Other
Enumeration date
01/05/2015
Last updated
01/05/2015
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