MEDICARE: MS. AMY NIELD

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	3761275	ID

General Provider Information

NPI Number	:	1871221408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY NIELD

Provider Business Mailing Address
First Line	:	1133 CALL CREEK DR STE A
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83201-3000
Country	:	US
Telephone Number	:	208-243-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 CALL CREEK DR
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83201-3000
Country	:	US
Telephone Number	:	208-243-8444
Fax Number	:

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	01/23/2025

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Directions to “ MS. AMY NIELD ” Practice Location

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