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Individual

MR. JASON MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PMHNP-BC

Contact information

Practice address
13734 S 1ST E, IDAHO FALLS, ID 83404-7852
(208) 360-0288
Mailing address
13734 S 1ST E, IDAHO FALLS, ID 83404-7852
(208) 360-0288

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
NP 1389A
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
NUR-RN-LIC-39018
MT

Other

Enumeration date
10/31/2013
Last updated
06/25/2020
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