Individual
ALYSSA MAY JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
535 W SUNNYSIDE RD STE 2, IDAHO FALLS, ID 83402-4647
(208) 357-9700
(208) 963-3245
Mailing address
4095 E MENAN LORENZO HWY, RIGBY, ID 83442-5169
(208) 847-5762
(208) 963-3245
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1966
ID
Other
Enumeration date
02/10/2021
Last updated
06/17/2025
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