Derek S Ahlstrom, PA
Physician Assistant in Boise, Idaho
1174096606- Practice location
- 7941 W Rifleman St, Boise, ID 83704-9001
- Phone
- 208-895-7950
- Fax
- —
- Last updated
- March 28, 2024
Derek S Ahlstrom, PA is a Physician Assistant based in Boise, ID. Derek S Ahlstrom, PA holds the professional credentials of PA. The NPI number for Derek S Ahlstrom, PA is 1174096606 and holds license No. PA61522965 (WA). The current practice location address is 7941 W Rifleman St, Boise, ID 83704-9001 and the office can be reached by phone at 208-895-7950. The NPI was assigned on January 8, 2019 and the record was last updated in NPPES on March 28, 2024.
●Provider Profile Details
- NPI Number
- 1174096606
- Provider Name
- Derek Scott Ahlstrom
- Credential
- PA
- Entity Type
- Individual (Type 1 NPI)
- Gender
- Male
- Primary Taxonomy
- Physician Assistant · 363A00000X
- Sole Proprietor
- No
- Enumeration Date
- January 8, 2019
- Last Update Date
- March 28, 2024
- Certification Date
- March 28, 2024
- NPI Status
- Active
◉Business Practice Location Address
- Address
- 7941 W Rifleman St
Boise, ID 83704-9001 - City
- Boise
- State
- Idaho
- ZIP
- 83704-9001
- Country
- US
- Phone Number
- 208-895-7950
✉Business Mailing Address
- Address
- 1650 S Topaz Way
Meridian, ID 83642-4474 - City
- Meridian
- State
- ID
- ZIP
- 83642-4474
- Phone Number
- 208-605-7070
✎Taxonomy & License Information
| Taxonomy | Code | Primary | License | State |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | No | PA61522965 | WA |
| Physician Assistant | 363A00000X | Yes | PA-1715 | ID |
#Other Provider Identifiers
No legacy or other identifiers (Medicaid, Medicare or plan IDs) are on file for this provider.
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View all providers in Boise →?Frequently Asked Questions
What is the NPI number of Derek S Ahlstrom, PA?
The NPI number of Derek S Ahlstrom, PA is 1174096606. It was assigned on January 8, 2019 and is currently active in the NPPES registry.
What is the specialty of Derek S Ahlstrom, PA?
Derek S Ahlstrom, PA is registered under the primary taxonomy Physician Assistant (code 363A00000X) and holds license No. PA61522965 (WA).
Where does Derek S Ahlstrom, PA practice?
The practice location is 7941 W Rifleman St, Boise, ID 83704-9001. The office can be reached at 208-895-7950 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1174096606 directly on the NPPES registry website at npiregistry.cms.hhs.gov.