Provider Demographics
NPI:1750783064
Name:TAYLOR, JESSICA VIEHWEG (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:VIEHWEG
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:
Practice Address - Street 1:738 N COLLEGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3385
Practice Address - Country:US
Practice Address - Phone:208-814-7000
Practice Address - Fax:208-734-7294
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-1234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant