National Provider Identifier Database

LYLE J JACKSON, CRNA – NPI #1225597305
Orthopedic


Contact Information

LYLE J JACKSON, CRNA
2325 CORONADO ST
IDAHO FALLS, ID83404-7407
Phone: 208-557-2700
Fax:
Website:
Specialty Taxonomy Code
* Orthopedic 163WX0800X
Nurse Anesthetist, Certified Registered 367500000X

* Indicates primary specialty

NPI Profile & details for LYLE J JACKSON

NPI Number 1225597305
Credentials CRNA (Certified Registered Nurse Anesthetist)
Entity Individual
Enumeration date 03/18/2019
Last updated 06/30/2025 - About 11 months ago
Sole proprietor1 Yes
Identifiers
  • IA License #: D183481
  • ID License #: 62439
  • VA License #: 125895
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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