Individual provider · Type 1 NPI

Jared Kent Wilson, PA-C, MPAS, MED, ATC

Surgical Physician Assistant · Pocatello, ID

NPI number 1275748089 Active

Practice location

777 Hospital Way, South Mob, Suite 204
Pocatello, ID 83201-5175

Fax (208) 239-2119

Specialties and licenses

TaxonomyCodeLicense
Athletic Trainer 2255A2300XAT-492 (ID)
Surgical Physician Assistant Primary 363AS0400XPA-952 (ID)

Surgical Physician Assistant: Definition to come...

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About NPI 1275748089

Jared Kent Wilson, PA-C, MPAS, MED, ATC's National Provider Identifier is 1275748089, issued on May 14, 2007. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Pocatello, ID. The record was last updated on Aug 3, 2025.