CHARISSE L MACK (NPI# 1801973615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801973615 |
| Entity Type | Individual |
| Full Name | CHARISSE L MACK |
| Credential | PA |
| Practice Address |
6140 Curtisian Ave Ste 400 Boise ID 83704-8880 |
| Mailing Address |
190 E Bannock St Boise ID 83712-6241 |
| Practice Telephone | 2083673500 |
| Practice Fax Number | 2083672968 |
| Mailing Telephone | 2083812222 |
| Mailing Fax Number | 2083672968 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-03-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA-632 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA632 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 807590500 | 05 | |
| ID | STATE OF WA DOL | 0214786 | 01 |
| ID | BLUE CROSS OF ID | PAD65 | 01 |
| ID | BLUE SHIELD OF ID | 000010158697 | 01 |
| Street Address |
6140 CURTISIAN AVE STE 400 |
| City | BOISE |
| State | ID |
| Zip Code | 83704-8880 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407814411 | Frederick R. Badke | Internal Medicine | 6140 Curtisian Ave, Suite 200, Boise, ID 83704-8880 | 2006-05-02 |
| 1043480445 | Jessica Garner | Specialist/Technologist, Other | 6140 Curtisian Ave, Boise, ID 83704-8880 | 2008-03-03 |
| 1457545691 | Idaho Heart Care | Internal Medicine | 6140 Curtisian Ave, Suite 200, Boise, ID 83704-8880 | 2007-08-30 |
| 1598968232 | Lauren A Musheno | Specialist/Technologist, Other | 6140 Curtisian Ave, Ste 400, Boise, ID 83704-8880 | 2007-06-08 |
| 1942330204 | Timothy J Johans, Md | Neurological Surgery | 6140 Curtisian Ave, Suite 400, Boise, ID 83704-8880 | 2007-03-06 |
| 1730219072 | Paul J Montalbano Md | Neurological Surgery | 6140 Curtisian Ave, Suite 400, Boise, ID 83704-8880 | 2007-03-06 |
| 1154489110 | Kelli J Goold | Specialist/Technologist, Other | 6140 Curtisian Ave, Ste 400, Boise, ID 83704-8880 | 2006-12-04 |
| 1033292644 | Alan G Upchurch | Specialist/Technologist, Other | 6140 Curtisian Ave, Ste 400, Boise, ID 83704-8880 | 2006-10-24 |
| 1760584346 | Stephanie M Hilpert | Nurse Practitioner | 6140 Curtisian Ave, Suite 400, Boise, ID 83704-8880 | 2006-09-02 |
| 1861501637 | Thomas Crellin Manning | Neurological Surgery | 6140 Curtisian Ave, Ste 400, Boise, ID 83704-8880 | 2006-08-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215535893 | Laura Diggs | Counselor | 400 North Benjamin Lane, Suite 200, Boise, ID 83704 | 2020-10-15 |
| 1891304002 | Tree City Family Dental | Dentist | 7301 W. Emerald St Ste. 102, Boise, ID 83704 | 2020-07-24 |
| 1982230710 | Jessica Wynn Councell | Midwife | 1072 N Liberty St Ste 100, Boise, ID 83704 | 2020-03-12 |
| 1699307124 | Isabel Burns Bruce | Registered Nurse | 777 N Raymond Street, Boise, ID 83704 | 2020-02-12 |
| 1558903328 | Daring In Idaho, LLC | Social Worker | 413 N Allumbaugh Street, Suite 102, Boise, ID 83704 | 2019-10-14 |
| 1053960286 | Kyle Hiromi Hatanaka | Acupuncturist | 9450 #120 Fairview Avenue, Boise, ID 83704 | 2019-09-10 |
| 1700447141 | Katie Elizabeth Nichols | Physician Assistant | 1072 N Liberty St Ste 201, Boise, ID 83704 | 2019-06-26 |
| 1588164727 | Cory Michael Sims | Counselor | 6550 W. Emerald St #112, Boise, ID 83704 | 2018-02-14 |
| 1477072270 | Matthew Lee Love | Non-emergency Medical Transport (VAN) | 6933 W. Stratton St, Boise, ID 83704 | 2017-09-12 |
| 1942735949 | Dalana Sue Thompson | Counselor | 9196 Emerald St Suite #130, Boise, ID 83704 | 2017-04-27 |
| Find all providers in zip 83704 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A 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 trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821695792 | Chelsea Dylan Tennent | Physician Assistant | 1666 E Gentlewind St, Boise, ID 83706-5914 | 2020-10-05 |
| 1871114553 | Samantha Tess Goodrich | Physician Assistant | 721 E Lenz St, Boise, ID 83712-7846 | 2020-05-04 |
| 1689131005 | Aftin Jade Martens | Physician Assistant | 303 N Allumbaugh St, Boise, ID 83704-9208 | 2019-02-21 |
| 1215418140 | Michael Edward Molnar | Physician Assistant | 2012 S Longmont Ave, Boise, ID 83706-4235 | 2018-08-28 |
| 1578059143 | Mckenzie Hart | Physician Assistant | 4334 S Aleut Way, Boise, ID 83709-6033 | 2018-07-07 |
| 1174035638 | Zacharia Njoroge | Physician Assistant | 1055 N Curtis Rd 6th Floor, Boise, ID 83706 | 2017-10-24 |
| 1073040242 | Nicole Ankenbrandt | Physician Assistant | 3151 S Terra Dr, Boise, ID 83709-3831 | 2017-05-17 |
| 1346792033 | Samantha Rae Lange | Physician Assistant | 1072 N Liberty St Ste 203, Boise, ID 83704 | 2016-10-27 |
| 1174070098 | Alexandra W Clapp | Physician Assistant | 6140 West Curtisian Avenue Suite 200, Boise, ID 83704 | 2016-09-08 |
| 1376914838 | Morgan Grace Roskelley | Physician Assistant | 703 S. Americana Blvd, Ste 120, Boise, ID 83702 | 2015-10-09 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.