Healthcare Provider Details

I. General information

NPI: 1104506567
Provider Name (Legal Business Name): CADEN JOHNSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16818 N MARKETPLACE BLVD
NAMPA ID
83687-5140
US

IV. Provider business mailing address

16818 N MARKETPLACE BLVD
NAMPA ID
83687-5140
US

V. Phone/Fax

Practice location:
  • Phone: 208-321-4000
  • Fax:
Mailing address:
  • Phone: 208-321-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: