Individual
BAYLEE BUCKLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1100 NW 12TH ST, FRUITLAND, ID 83619-5040
(208) 452-6556
Mailing address
2090 E HORSE CREEK ST, MERIDIAN, ID 83642-6729
(208) 431-2309
Taxonomy
Speciality
Code
Description
License number
State
2471C3401X
Computed Tomography Radiologic Technologist
578041
ID
363AM0700X
Medical Physician Assistant
Primary
6761478
ID
Other
Enumeration date
08/05/2022
Last updated
01/28/2025
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