Staker, Tate Coltan

Staker, Tate Coltan is an sole proprietor health care provider with primary practice located at 130 W Main St , Rexburg ID 83440-1827. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Staker, Tate Coltan can be contacted via phone (208) 356-8818.

Contact Information

Primary practice address
130 W Main St Rexburg ID 83440-1827
Phone: (208) 356-8818
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA-1932 Idaho

Profile Details

NPI number 1184253585
LBN Legal business name Staker, Tate Coltan
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 7th, 2020
Last updated Oct 28th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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