Provider Demographics
NPI:1407225212
Name:AYERS, BRIANNE (PA)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:AYERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 N CURTIS RD
Mailing Address - Street 2:STE 303
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1337
Mailing Address - Country:US
Mailing Address - Phone:208-377-4000
Mailing Address - Fax:208-375-8426
Practice Address - Street 1:6051 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8969
Practice Address - Country:US
Practice Address - Phone:208-302-5150
Practice Address - Fax:208-302-5155
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-1291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant