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

Connor Johnson, PA

Individual provider Physician Assistant · NPI 1275401523

Connor Johnson, PA is a Physician Assistant in Boise, Idaho. Qualified in 2025, 1 year ago. Licensed in Idaho.

Years since qualifying
1
Licensed in
ID
In the registry since
2025
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

190 E Bannock St
Boise, ID 83712-6241
Phone: (801) 884-7614
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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 2571593 (ID)

Record details

NPI number1275401523
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 28, 2025
Last updated in NPPESFebruary 11, 2026
Certification dateFebruary 11, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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