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

Eleanor Rose Wilson, PA-C

Individual provider Physician Assistant · NPI 1336871623

Eleanor Rose Wilson, PA-C is a Physician Assistant in Boise, Idaho. Qualified in 2023, 3 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
3
Licensed in
ID
In the registry since
2022
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

100 E Idaho St Ste 302
Boise, ID 83712-6269
Phone: (208) 343-7501
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 921 S. 8th Ave, Stop 8253, Pocatello, ID 83709 — (208) 282-4726

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-2592 (ID)

Record details

NPI number1336871623
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 27, 2022
Last updated in NPPESJuly 28, 2025
Certification dateJuly 28, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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