Healthcare Provider Details

I. General information

NPI: 1295787240
Provider Name (Legal Business Name): SCOTT B BURNETT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N 1ST ST SUITE 280
BOISE ID
83702-6100
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-345-6545
  • Fax: 208-345-1213
Mailing address:
  • Phone: 208-345-6545
  • Fax: 208-345-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA-384
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA226622
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: