JARED MUDGE PA-C NPI 1679398929

NPI Information

  • NPI: 1679398929
  • Provider Name: JARED MUDGE, PA-C
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: PO BOX 388
    PLUMMER, ID
    ZIP 83851
  • Phone: (208) 686-5133

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NPI Details

Jared Mudge, PA-C is a medical physician assistant in Plummer, ID with 4 years of experience. Jared Mudge, PA-C NPI is 1679398929. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

PO BOX 388
PLUMMER, ID
ZIP 83851-388
Phone: (208) 686-5133

The NPI 1679398929 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/21/2024 and was last updated on 11/21/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedical5761672IDAHOYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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