Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Tate Coltan Staker, PA-C

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1184253585

Tate Coltan Staker, PA-C is a Physician Assistant in Rexburg, Idaho. Qualified in 2020, 6 years ago. Practices with Mountain View Hospital LLC, a 267-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
6
Licensed in
ID
In the registry since
2020
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

130 W Main St
Rexburg, ID 83440-1827
Phone: (208) 356-8818
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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-1932 (ID)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1184253585
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedApril 7, 2020
Last updated in NPPESOctober 28, 2021
Certification dateOctober 28, 2021

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Mountain View Hospital Llc — 267 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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