Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tai Banta

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1467185843

Tai Banta is a Physician Assistant in Idaho Falls, Idaho. Qualified in 2022, 4 years ago. Practices with Mark E Hinkson Dermatology PA, a 4-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
4
Licensed in
ID
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

14107 N 5th E
Idaho Falls, ID 83401-5105
Phone: (208) 881-7462
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 921 S 8th Ave Stop 8253, Pocatello, ID 83209-0002 — (208) 282-4726

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (ID)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1467185843
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 5, 2022
Last updated in NPPESOctober 14, 2022
Certification dateOctober 14, 2022
Mailing address14107 N 5th E, Idaho Falls, ID 83401-5105

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Mark E Hinkson Dermatology Pa — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Idaho Falls