Ariel Shantay Avis Taysom, PA-C

NPI #1609341098 in Malad City, Idaho

Provider Information

NPI Number: 1609341098
Entity Type: Individual
Name: Ariel Shantay Avis Taysom, PA-C
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Oct 11, 2018
Last Updated: Nov 16, 2021

Practice Location

Address: 220 BANNOCK ST
City: Malad City
State: Idaho
ZIP Code: 83252-5068
Phone: (208) 766-2600

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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