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

Jackie B Callaway, PA

Individual provider Physician Assistant · NPI 1801196720

Jackie B Callaway, PA is a Physician Assistant in Boise, Idaho. Qualified in 2010, 16 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
16
Licensed in
ID
In the registry since
2010
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

600 N Robbins Rd Ste 302
Boise, ID 83702-4565
Phone: (208) 706-5930
Fax: (208) 706-5942
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 7979 W. Rifleman St., Boise, ID 83704 — (208) 321-4000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-865 (ID)

Record details

NPI number1801196720
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 26, 2010
Last updated in NPPESAugust 23, 2023
Certification dateAugust 23, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2010 (16 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 locations3 on file with Medicare

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