Ariel Shantay Avis Taysom, PA-C
Ariel Shantay Avis Taysom, PA-C is a Physician Assistant in Malad City, Idaho. Qualified in 2018, 8 years ago. Practices with Cc Pocatello LLC, a 6-clinician group and accepts Medicare assignment. Licensed in Idaho.
- Years since qualifying
- 8
- Licensed in
- ID
- In the registry since
- 2018
What do these letters mean?
- PA-C — Physician Assistant, Certified
- A physician assistant who holds current national certification.
Practice location Address checks out
220 Bannock StMalad City, ID 83252-5068
Phone: (208) 766-2600
Fax: (208) 766-4258
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Physician Assistant (primary) | Taxonomy 363A00000X · Licence PA-1656 (ID) |
|---|
Record details
| NPI number | 1609341098 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Credentials | PA-C |
| Sole proprietor | Yes |
| NPI enumerated | October 11, 2018 |
| Last updated in NPPES | November 16, 2021 |
| Certification date | November 16, 2021 |
Medicare enrollment
| Medicare specialty | PHYSICIAN ASSISTANT |
|---|---|
| Medical school | OTHER |
| Graduated | 2018 (8 years in practice) |
| Group practice | Cc Pocatello Llc — 6 clinicians |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |
Other providers in Malad City
-
Mel Bingham, PA-C
220 Bannock St, Malad City, ID 83252-5068 · (208) 766-2600
-
Rick C. Clark Jr., PA
220 Bannock St Ste 306, Malad City, ID 83252-1256 · (208) 766-2600
-
Robert Todd Gillespie, PA
220 Bannock St Ste B, Malad City, ID 83252-1256 · (208) 766-2600