Individual
TIFFANY C COUGHENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3200 CHANNING WAY, STE 205, IDAHO FALLS, ID 83404-7546
(208) 535-4300
(208) 535-4315
Mailing address
2985 CORTEZ AVE, STE 200, IDAHO FALLS, ID 83404-7554
(208) 535-4300
(208) 535-4315
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA244
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805523500
—
ID
Enumeration date
04/09/2007
Last updated
09/13/2016
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