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JACOB DANIEL WALLER
NPI 1295428191
Student in an Organized Health Care Education/Training Program in Moscow, ID

Active since May 29, 2023
875 PERIMETER DR, MOSCOW, ID 83844(208) 885-6111 Get Directions Write a Review

NPPES record last updated: May 29, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jacob Daniel Waller NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACOB DANIEL WALLER (NPI 1295428191) is an individual student in an organized health care education/training program in Moscow, Idaho and active in the NPI registry since May 2023.

NPPES Registry Identity

NPI1295428191
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJACOB DANIEL WALLER
Location Address875 PERIMETER DRMoscow, ID 83844-9803
Mailing Address11645 W Cross Slope WayNampa, ID 83686-5674 · (925) 522-9815
Phone(208) 885-6111
Sole ProprietorNo
Enumeration DateMay 29, 2023
NPPES CertifiedMay 28, 2023
✔ NPI 1295428191 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Also ListedSpecialist/TechnologistTaxonomy 235500000X
875 PERIMETER DR, Moscow, ID 83844
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JORDAN KOPSHO
Student in an Organized Health Care Education/Training Program
875 PERIMETER DR
MOSCOW, ID 83844
Latah County (208) 885-6111
NATSUMI KURIBAYASHI LAT, ATC
Specialist/Technologist (Athletic Trainer)
875 PERIMETER DR
MOSCOW, ID 83844
Latah County (208) 885-0256
LOGAN FREDERICK PRINS
Specialist/Technologist (Athletic Trainer)
875 PERIMETER DR
MOSCOW, ID 83844
Latah County (816) 868-1839
VANESSA NICOLE PADILLA
Student in an Organized Health Care Education/Training Program
875 PERIMETER DR
MOSCOW, ID 83844
Latah County (208) 885-6111
HUNTER AUGUSTUS CONNOLLEY
Specialist/Technologist (Athletic Trainer)
875 PERIMETER DR
MOSCOW, ID 83844
Latah County (208) 885-6111
BROOKE LOPEZ
Student in an Organized Health Care Education/Training Program
875 PERIMETER DR
MOSCOW, ID 83844
Latah County (208) 885-6111
NASIHA IFTIAZ
Student in an Organized Health Care Education/Training Program
875 PERIMETER DR
MOSCOW, ID 83844
Latah County (208) 885-6111
TAIYLER JADE SODERQUIST ATC, NREMT
Specialist/Technologist (Athletic Trainer)
875 PERIMETER DR
MOSCOW, ID 83844
Latah County (208) 885-6111

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Waller's NPI number?

The NPI number for Jacob Waller is 1295428191. It was assigned to this individual provider in the NPPES registry on May 29, 2023.

Where is Jacob Waller located?

Jacob Waller practices at 875 Perimeter Dr, Moscow, ID 83844. The listed phone number is (208) 885-6111.

What is Jacob Waller's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Jacob Waller was last updated on May 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.