Healthcare Provider Details

I. General information

NPI: 1689362444
Provider Name (Legal Business Name): ABBY FRANCES JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N CURTIS RD STE 415
BOISE ID
83706-1334
US

IV. Provider business mailing address

PO BOX 190930
BOISE ID
83719-0930
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-2600
  • Fax: 208-302-2625
Mailing address:
  • Phone: 208-367-5170
  • Fax: 208-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8181020
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: