Healthcare Provider Details

I. General information

NPI: 1386944577
Provider Name (Legal Business Name): JENNIFER L SUTHERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L HESS PA-C

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 CHANNING WAY STE A
IDAHO FALLS ID
83404-7875
US

IV. Provider business mailing address

3155 CHANNING WAY STE A
IDAHO FALLS ID
83404-7875
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-6044
  • Fax: 208-523-4862
Mailing address:
  • Phone: 208-522-6044
  • Fax: 208-524-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 864
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: