Healthcare Provider Details

I. General information

NPI: 1326526963
Provider Name (Legal Business Name): TAYLOR S CURTIS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N 3RD E
REXBURG ID
83440-1629
US

IV. Provider business mailing address

1140 VILLA VISTA DR
AMMON ID
83406-1269
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-7585
  • Fax: 208-356-7566
Mailing address:
  • Phone: 208-356-7585
  • Fax: 208-356-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2221
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60879664
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: