Healthcare Provider Details

I. General information

NPI: 1407716152
Provider Name (Legal Business Name): JENNY CAUDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY SCRUGGS

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 16TH ST
IDAHO FALLS ID
83404-5919
US

IV. Provider business mailing address

111 E 16TH ST
IDAHO FALLS ID
83404-5919
US

V. Phone/Fax

Practice location:
  • Phone: 208-523-1130
  • Fax: 208-529-6501
Mailing address:
  • Phone: 208-523-1130
  • Fax: 208-529-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: