Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Callysta Johnston, PA-C

Individual provider Physician Assistant · NPI 1194489898

Callysta Johnston, PA-C is a Physician Assistant in Meridian, Idaho. Qualified in 2021, 5 years ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
5
Licensed in
ID
In the registry since
2021
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

4949 S Hillsdale Ave
Meridian, ID 83642-7586
Phone: (208) 706-6400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 500 W Fort St, Boise, ID 83702-4501 — (208) 422-1000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-2118 (ID)

Record details

NPI number1194489898
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 28, 2021
Last updated in NPPESJune 7, 2023
Certification dateJune 7, 2023
Mailing address190 E Bannock St, Boise, ID 83712-6241

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Meridian