Individual
AUSTIN JAY CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2210 CORONADO ST, IDAHO FALLS, ID 83404-7552
(208) 522-3355
Mailing address
5984 FENWOOD LN, AMMON, ID 83406
(208) 604-5167
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2448
ID
363AM0700X
Medical Physician Assistant
PA-2448
ID
363AS0400X
Surgical Physician Assistant
PA-2448
ID
Other
Enumeration date
01/31/2023
Last updated
10/07/2024
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