Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Charisse L Mack, PA

Individual provider Physician Assistant · NPI 1801973615

Charisse L Mack, PA is a Physician Assistant in Boise, Idaho. Qualified in 2006, 20 years ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Idaho.

Years since qualifying
20
Licensed in
ID
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

6140 Curtisian Ave Ste 400
Boise, ID 83704-8880
Phone: (208) 367-3500
Fax: (208) 367-2968
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-632 (ID)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA632 (ID)

Record details

NPI number1801973615
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedNovember 1, 2006
Last updated in NPPESMarch 4, 2013

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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