MEDICARE: TAREYN LYN GOSSLER-GREEN PA

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
2	363A00000X	Physician Assistant	PA-2364	ID

General Provider Information

NPI Number	:	1689316796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAREYN LYN GOSSLER-GREEN PA

Provider Business Mailing Address
First Line	:	2002 W PULLMAN RD
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-4012
Country	:	US
Telephone Number	:	208-883-8372
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 E 29TH AVE STE 100
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-4868
Country	:	US
Telephone Number	:	509-724-4320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2022
Last Update Date	:	05/15/2026

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Directions to “ TAREYN LYN GOSSLER-GREEN PA” Practice Location

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