Individual
JAMES TYLER CHRISTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-1647
(208) 535-4130
(208) 535-4125
Mailing address
2860 CHANNING WAY SUITE 115, PO BOX 1647, IDAHO FALLS, ID 83404-1647
(208) 535-4130
(208) 535-4125
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-402
ID
363AM0700X
Medical Physician Assistant
Primary
PA402
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806420100
—
ID
01
—
PASQ2
BLUE CROSS
ID
Enumeration date
12/30/2005
Last updated
05/28/2010
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