Healthcare Provider Details

I. General information

NPI: 1871092189
Provider Name (Legal Business Name): JOSEPH WELLS HOSKIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MCKENNA DR
MOUNTAIN HOME ID
83647-2143
US

IV. Provider business mailing address

3730 NE EAGLE CREEK CT
MOUNTAIN HOME ID
83647-6164
US

V. Phone/Fax

Practice location:
  • Phone: 208-587-9703
  • Fax:
Mailing address:
  • Phone: 412-715-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1601
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: