IndividualActive
Jared Wilson, PA-C, MPAS, MED, ATC
NPI 1275748089 · Surgical Physician Assistant · Pocatello, ID
Provider details
- NPI number
- 1275748089
- Entity type
- Individual
- Primary specialty
- Surgical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C, MPAS, MED, ATC
- Sex
- Male
- Sole proprietor
- No
- License
- AT-492 (ID)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
777 Hospital Way
South Mob, Suite 204
Pocatello, ID 83201-5175
Phone: (208) 239-2110
Fax: (208) 239-2119
Approximate (ZIP-level) locationGet directions
Mailing address
777 Hospital Way
Pocatello, ID 83201-5175
Registry dates
- Enumerated
- 2007-05-14
- Last updated
- 2025-08-03
- Certified
- 2025-08-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.