Individual
MR. JACOB C REEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1986 W. HAYDEN AVE, HAYDEN, ID 83835-7412
(208) 762-7760
(208) 762-7740
Mailing address
1986 W. HAYDEN AVE, HAYDEN, ID 83835-7412
(208) 762-7760
(208) 762-7740
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1010320
TX
Other
Enumeration date
08/26/2020
Last updated
12/20/2023
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