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

Landon Mitchel Favero

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1801363577

Landon Mitchel Favero is a Physician Assistant in Boise, Idaho. Qualified in 2018, 8 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 and Utah.

Years since qualifying
8
Licensed in
ID, UT
In the registry since
2018
Specialties on file
3
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Practice location Address checks out

701 E Parkcenter Blvd
Boise, ID 83706-6528
Phone: (208) 381-6500
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 475 N 500 W, Vernal, UT 84078-1907 — (801) 915-7265

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-2428 (ID)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X
Physician Assistant Taxonomy 363A00000X · Licence 11240954-1206 (UT)

Record details

NPI number1801363577
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 31, 2018
Last updated in NPPESAugust 22, 2023
Certification dateAugust 22, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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