Individual
TAYLOR ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
910 NW 16TH ST STE 101, FRUITLAND, ID 83619-2265
(208) 452-8000
(208) 452-8055
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2740
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/01/2022
Last updated
04/11/2024
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