Individual provider · Type 1 NPI

Bradley James Heninger, PA-C

Medical Physician Assistant · Fruitland, ID

NPI number 1205103389 Active

Practice location

910 NW 16th Street, Ste 205
Fruitland, ID 83619

Call (208) 452-3111 Map

Fax (208) 452-3666

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant 363AM0700XNone listed
Medical Physician Assistant Primary 363AM0700XPA-1026 (ID)

Medical Physician Assistant: Definition to come...

4 other providers at this address

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About NPI 1205103389

Bradley James Heninger, PA-C's National Provider Identifier is 1205103389, issued on Nov 17, 2011. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Fruitland, ID. The record was last updated on Feb 17, 2016.