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NPI Code Detail

MEDICARE: MICHAEL JEFFREY FARLEY PA-C

MEDICARE: MICHAEL JEFFREY FARLEY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant57691CA
2363A00000XPhysician Assistant
3363A00000XPhysician Assistant3871481ID

General Provider Information

NPI Number : 1548802416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JEFFREY FARLEY PA-C
Provider Business Mailing Address
First Line : PO BOX 190930
Second Line :
City : BOISE
State : ID
Zip : 83719-0930
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1510 12TH AVE RD STE 200
Second Line :
City : NAMPA
State : ID
Zip : 83686-6946
Country : US
Telephone Number : 208-302-6800
Fax Number : 208-302-6855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2019
Last Update Date : 01/14/2026

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Directions to “ MICHAEL JEFFREY FARLEY PA-C” Practice Location

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