Provider Demographics
NPI:1457596413
Name:RYE, JARED T (NP)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:T
Last Name:RYE
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-0600
Mailing Address - Fax:208-302-0755
Practice Address - Street 1:1510 12TH AVENUE RD
Practice Address - Street 2:STE 200
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686
Practice Address - Country:US
Practice Address - Phone:208-302-0600
Practice Address - Fax:208-302-0755
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDNP-889A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner