Willes, Jeremy David

Willes, Jeremy David is an individual health care provider with primary practice located at 260 Falls Ave Suite C, Twin Falls ID 83301-3370. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Willes, Jeremy David can be contacted via phone (208) 736-7422.

Contact Information

Primary practice address
260 Falls Ave Suite C Twin Falls ID 83301-3370
Phone: (208) 736-7422
Fax: (208) 736-8905
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA638 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA882 Nevada

Profile Details

NPI number 1356314843
LBN Legal business name Willes, Jeremy David
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 7th, 2006
Last updated May 8th, 2013 - about 11 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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Identifiers

StateTypeNumberIssuer
All States NPI 1356314843 NPPES
Idaho Other 000010161378 BLUE SHIELD
Idaho MEDICAID 807683300 BLUE SHIELD
Idaho MEDICAID 807683301 BLUE SHIELD
Idaho Other PAE68 BLUE SHIELD
Idaho Other 000010161377 BLUE SHIELD
Idaho MEDICAID 100504125 BLUE SHIELD
Idaho Other PAE69 BLUE SHIELD

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