Individual
JASON LEE COTTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
777 HOSPITAL WAY, SUITE 101, POCATELLO, ID 83201-5175
(208) 239-3899
(208) 232-2195
Mailing address
P.O. BOX 4168, POCATELLO, ID 83205-4168
(208) 239-1035
(208) 239-3626
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
CT66258
ID
363A00000X
Physician Assistant
Primary
9071482
ID
363A00000X
Physician Assistant
—
—
Other
Enumeration date
08/11/2023
Last updated
10/27/2025
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