Individual
MR. BRAYDEN LEE STOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
921 S 8TH AVE, POCATELLO, ID 83209-8219
(208) 282-4636
Mailing address
538 DELL RD, CHUBBUCK, ID 83202-2519
(208) 339-1580
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/21/2026
Last updated
01/21/2026
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