NPI age
6 years
Enumerated 2020-04-07
● Active
Type 1 · Individual
Tate Coltan Staker, PA-C
Staker is 1 of 23 physician assistant providers in Rexburg and 1 of 1263 in Idaho.
Primary specialty
Physician Assistant
Plus 1 subspecialty
Licensed in
ID
1 state
Status
Active
No deactivations on record
Last NPPES update
2021-10-28
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 1263 active physician assistant providers in Idaho.
NPI age
6 years
↓ 3 yr below median (9 yr)
State licenses
1 state
19% of peers hold multiple states
Subspecialties
1
In the 35% of peers with subspecialties
NPI lifetime · 2020 → 2026
2020-04Enumerated in NPPES
2020
2026
Where they practice
Practice location
130 W Main St
Rexburg, ID 834401827
Mailing address
130 W Main St
Rexburg, ID 834401827
Specialties
-
Physician Assistant PrimaryA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally...
-
Student in an Organized Health Care Education/Training ProgramAn 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.
Practice context
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
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