Jace Patrick Puckett
Specialist/Technologist, Athletic Trainer in Moscow, ID. Individual provider (NPI-1).
NPI number1982196291
StatusActive
Last updated in NPPESJun 1, 2018
Details
- NPI
- 1982196291
- Entity type
- Individual (NPI-1)
- Name
- Jace Patrick Puckett
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 1, 2018
- Last updated
- Jun 1, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – | Yes |
Practice location
875 Perimeter DrMoscow, ID 83844-9803
Phone 775-351-8297
Mailing address
2306 White Ave Apt 203Moscow, ID 83843-5099
Phone 775-351-8297
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