Healthcare Provider Details

I. General information

NPI: 1003867664
Provider Name (Legal Business Name): EMILY G KARASSIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 AVIATION DR SUITE 100
HAILEY ID
83333-8785
US

IV. Provider business mailing address

PO BOX 587
TWIN FALLS ID
83303-0587
US

V. Phone/Fax

Practice location:
  • Phone: 208-788-3434
  • Fax: 208-788-2025
Mailing address:
  • Phone: 208-814-7400
  • Fax: 208-814-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-237
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: