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

Lacy Rose Wagner, PA

Individual provider Physician Assistant · NPI 1508537507

Lacy Rose Wagner, PA is a Physician Assistant in Boise, Idaho. Qualified in 2021, 5 years ago. Practices with Saint Alphonsus Regional Medical Center Inc, a 673-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
5
Licensed in
ID
In the registry since
2021
Specialties on file
2
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

6051 W Emerald St
Boise, ID 83704-8969
Phone: (208) 302-5150
Fax: (208) 302-5155
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1856 E Fireside Dr, Meridian, ID 83642-1118 — (805) 748-9554

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-2169 (ID)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1508537507
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 21, 2021
Last updated in NPPESJanuary 26, 2022
Certification dateJanuary 26, 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 Saint Alphonsus Regional Medical Center Inc — 673 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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