Healthcare Provider Details

I. General information

NPI: 1437350774
Provider Name (Legal Business Name): DAWN ARIEL JENNINGS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAWN JENNINGS-PETERSON MD

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 6TH ST
RUPERT ID
83350-1619
US

IV. Provider business mailing address

794 EASTLAND DR
TWIN FALLS ID
83301-6856
US

V. Phone/Fax

Practice location:
  • Phone: 208-650-7941
  • Fax:
Mailing address:
  • Phone: 208-737-6718
  • Fax: 208-734-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-14157
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: