Jackson, Lyle Jeremy

Jackson, Lyle Jeremy is an sole proprietor health care provider with primary practice located at 2325 Coronado St , Idaho Falls ID 83404-7407. He recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Orthopedic, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Nursing Service Providers / Orthopedic is his primary health care specialty. Jackson, Lyle Jeremy can be contacted via phone (208) 557-2700.

Contact Information

Primary practice address
2325 Coronado St Idaho Falls ID 83404-7407
Phone: (208) 557-2700
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Orthopedic 163WX0800X 62439 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 125895 Virginia

Profile Details

NPI number 1225597305
LBN Legal business name Jackson, Lyle Jeremy
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 18th, 2019
Last updated Sep 14th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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