JACOB SHANE TEBBS (NPI# 1154870251) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154870251 |
| Entity Type | Individual |
| Full Name | JACOB SHANE TEBBS |
| Credential | PA-C |
| Practice Address |
6051 N Eagle Rd Boise ID 83713-0997 |
| Mailing Address |
1900 N State St Provo UT 84604-1305 |
| Practice Telephone | 2085194333 |
| Practice Fax Number | 2082059134 |
| Mailing Telephone | 8013732001 |
| Enumeration Date | 2016-09-29 |
| Last Update Date | 2020-08-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
10103875-1206 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 999 N Curtis Rd Ste 307, Boise, ID 837061333 | 2085194333 | 2082059134 |
| Street Address |
6051 N EAGLE RD |
| City | BOISE |
| State | ID |
| Zip Code | 83713-0997 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063462075 | Gary J Millward | Podiatrist | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2006-05-11 |
| 1598271645 | Treasure Valley Dermatology & Skin Cancer Center, Pllc | Dermatology | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2017-12-26 |
| 1588002547 | Dustin Ray Portela | Dermatology | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2013-06-11 |
| 1952628745 | Ryan J Harris | Dermatology | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2010-05-03 |
| 1407047202 | Mariya Rose Ostermiller | Physician Assistant | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2007-08-06 |
| 1104975168 | Clinton Clark Dpm LLC | Podiatrist | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2007-01-09 |
| 1982711578 | Boise Podiatry Clinic, P. A. | Podiatrist | 6051 N Eagle Rd, Boise, ID 83713 | 2006-08-23 |
| 1578514618 | Scott A Graviet | Podiatrist | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2006-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
| 1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
| 1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
| 1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
| 1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
| 1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
| Find all providers in zip 83713 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073915963 | Jessica Bishop | Physician Assistant | 1499 W Hays St, Boise, ID 83702-5029 | 2014-09-23 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1710231238 | Alaina A Mccoy | Physician Assistant | 100 E. Idaho St., Suite 400, Boise, ID 83712 | 2012-11-06 |
| 1447534821 | Addie Barnes | Physician Assistant | 900 N Liberty, Ste 101, Boise, ID 83704 | 2011-10-04 |
| 1134358104 | Eric Culbertson | Physician Assistant | 633n 4th St, Boise, ID 83702-4510 | 2009-07-10 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1598921595 | Karen B. Barrett | Physician Assistant | 6000 W. Overland Road, Firstline Medical, Boise, ID 83704 | 2008-07-30 |
| 1972672111 | Kara Mcgee | Physician Assistant | 727 E Riverpark Ln Ste 200, Boise, ID 83706-4097 | 2006-11-06 |
| 1265464036 | Sharene E Watsen | Physician Assistant | 403 South 11th St, Ste 100, Boise, ID 83702-6906 | 2006-07-06 |
| 1508802091 | Heidi R Munro | Physician Assistant | 8000 S Federal Way, Boise, ID 83716-9632 | 2006-06-22 |
| Find all providers in BOISE | ||||
Please comment or provide details below to improve the information on JACOB SHANE TEBBS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.