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

Cody Johnson

Individual provider Physician Assistant · NPI 1184392011

Cody Johnson is a Physician Assistant in Boise, Idaho. Qualified in 2021, 5 years ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Idaho.

Years since qualifying
5
Licensed in
ID
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

190 E Bannock St Fl 10
Boise, ID 83712-6241
Phone: (208) 381-5500
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 407 S Schwartz Ave Ste 101, Farmington, NM 87401-5925 — (505) 609-6595

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-2399 (ID)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1184392011
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 3, 2021
Last updated in NPPESNovember 30, 2022
Certification dateNovember 30, 2022

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
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

Other providers in Boise