Individual
TYSON DARRELL GREENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
260 E 5TH ST N, BURLEY, ID 83318-3453
(208) 678-9760
(208) 678-9758
Mailing address
684 E 400 N, RUPERT, ID 83350-9460
(208) 670-7008
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
6571244
ID
Other
Enumeration date
10/18/2023
Last updated
02/07/2025
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