Healthcare Provider Details

I. General information

NPI: 1184579237
Provider Name (Legal Business Name): TELICIA MARIE SAARI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DESERT SAGE WAY
MOUNTAIN HOME ID
83647-1038
US

IV. Provider business mailing address

1365 MERRETT DR
IDAHO FALLS ID
83404-5416
US

V. Phone/Fax

Practice location:
  • Phone: 208-587-3988
  • Fax:
Mailing address:
  • Phone: 208-541-4982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: