NPI 1073231999

Johnathon Chase Wilde, PAC

Practitioner Physician Assistant Idaho Falls, ID

Practice location

Address: 3820 Crestwood Ln, Idaho Falls, ID 83404-4979
Phone: (208) 552-7700

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 8361377 (ID)

Other Physician Assistant providers in Idaho →

Registry record

NPI: 1073231999
Entity type: Individual
Sex (as registered): Male
NPI issued: 16 Aug 2022
Record last updated: 26 Sep 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.