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General NPI Number Information
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NPI Number | 1144045220
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Entity Type | Individual
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Provider Name | JAYNE FEKETE
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Gender | Female
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 1771 E PINE AVE
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City | MERIDIAN
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State | ID
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Zip | 83642-5914
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Country | US
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Telephone | 208-880-2895
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Fax |
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Provider Business Mailing Address
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Address Line | 8262 S SLIDE CREEK LN
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City | MERIDIAN
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State | ID
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Zip | 83642-7192
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Country | US
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Telephone | 208-880-2895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | DDA-6230
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License Number State | ID
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