Provider Demographics
NPI:1437350774
Name:JENNINGS, DAWN ARIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ARIEL
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:JENNINGS-PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:794 EASTLAND DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6856
Mailing Address - Country:US
Mailing Address - Phone:208-737-6718
Mailing Address - Fax:208-734-5036
Practice Address - Street 1:402 6TH ST
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1619
Practice Address - Country:US
Practice Address - Phone:208-650-7941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-14157207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500607972Medicaid
ORR149347Medicare PIN