MEDICARE: SNAKE RIVER WELLNESS PLLC

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1649156142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNAKE RIVER WELLNESS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 102
Second Line	:
City	:	GLENNS FERRY
State	:	ID
Zip	:	83623-0102
Country	:	US
Telephone Number	:	208-366-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 N COMMERCIAL ST
Second Line	:
City	:	GLENNS FERRY
State	:	ID
Zip	:	83623-2342
Country	:	US
Telephone Number	:	208-366-1200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARIN M HOWARD
Credential	:	PA-C
Telephone Number	:	208-366-1200

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/20/2025

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Directions to “SNAKE RIVER WELLNESS PLLC ” Practice Location

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