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

Mackenzie Marie Gomez, PA-C

Individual provider Physician Assistant · NPI 1649059197

Mackenzie Marie Gomez, 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 Florida and Idaho.

Years since qualifying
3
Licensed in
FL, ID
In the registry since
2023
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

417 S 6th St
Boise, ID 83702-7632
Phone: (208) 577-4460
Fax: (208) 577-4469
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

Additional practice locations (1)

  • 169 Sw 5th Ct, Deerfield Beach, FL 33441-4620 — (904) 245-8910

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 4871647 (ID)
Physician Assistant Taxonomy 363A00000X · Licence 1200715 (FL)

Record details

NPI number1649059197
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 25, 2023
Last updated in NPPESMarch 10, 2025
Certification dateMarch 10, 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 locations3 on file with Medicare

Other providers in Boise