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

Javlyn Dickson Weaver, PA

Individual provider Physician Assistant · NPI 1528774932

Javlyn Dickson Weaver, PA is a Physician Assistant in Mountain Home, Idaho. Qualified in 2022, 4 years ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
4
Licensed in
UT
In the registry since
2023
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

895 N 6th E
Mountain Home, ID 83647-2207
Phone: (208) 587-8401
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 12989329-1206 (UT)

Record details

NPI number1528774932
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJanuary 30, 2023
Last updated in NPPESJanuary 30, 2023
Certification dateJanuary 28, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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