Henry Rainbolt III, PA-C
Physician Assistant in Burley, ID. Individual provider (NPI-1).
NPI number1134769367
StatusActive
Last updated in NPPESFeb 24, 2025
Details
- NPI
- 1134769367
- Entity type
- Individual (NPI-1)
- Name
- Henry Rainbolt III
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 15, 2020
- Certification date
- Feb 5, 2025
- Last updated
- Feb 24, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA-2721 | ID | Yes |
Practice location
382 N Overland AveBurley, ID 83318-3433
Phone 208-933-4442
Mailing address
382 N Overland AveBurley, ID 83318-3433
Phone 208-933-4442
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