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General NPI Number Information
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NPI Number | 1255482683
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Entity Type | Individual
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Provider Name | SCOTT MICHAEL ASTLEY PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/14/2007
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 8854 W EMERALD ST STE 290
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City | BOISE
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State | ID
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Zip | 83704-4846
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Country | US
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Telephone | 208-296-7500
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Fax | 208-296-7501
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Provider Business Mailing Address
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Address Line | 8854 W EMERALD ST STE 290
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City | BOISE
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State | ID
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Zip | 83704-4846
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Country | US
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Telephone | 208-296-7500
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Fax | 208-296-7501
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2365
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-1370
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License Number State | ID
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