CHARISSE L MACK


Address: 6140 Curtisian Ave, Ste 400, Boise, ID 83704-8880
Phone: 2083673500

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

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

Office Location

Street Address 6140 CURTISIAN AVE
STE 400
City BOISE
State ID
Zip Code 83704-8880

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

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.

Providers in the same taxonomy and city

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
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Competitor

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City BOISE
Zip Code 83704

Improve Information

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Dataset Information

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.

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