Provider Demographics
NPI:1215001417
Name:CAFFERTY, ASHLEY BRYN (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BRYN
Last Name:CAFFERTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5107 FRUITHILL PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5108
Mailing Address - Country:US
Mailing Address - Phone:208-562-0585
Mailing Address - Fax:
Practice Address - Street 1:999 N CURTIS RD STE 505
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1335
Practice Address - Country:US
Practice Address - Phone:208-327-9521
Practice Address - Fax:208-327-9524
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant