NPI 1184253585

Tate Coltan Staker, PAC

Practitioner Physician Assistant Rexburg, ID

Practice location

Address: 130 W Main St, Rexburg, ID 83440-1827
Phone: (208) 356-8818

Registered specialties (2)

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence PA-1932 (ID)

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Student in an Organized Health Care Education/Training Program

Student, Health Care Taxonomy 390200000X

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Registry record

NPI: 1184253585
Entity type: Individual
Sex (as registered): Male
NPI issued: 7 Apr 2020
Record last updated: 28 Oct 2021

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.