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

Mr. Liam Andrew Wickenburg

Individual provider Physician Assistant · NPI 1750074563

Mr. Liam Andrew Wickenburg is a Physician Assistant in Meridian, Idaho. Qualified in 2025, 1 year 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.

Years since qualifying
1
Licensed in
ID
In the registry since
2023
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Practice location Address checks out

520 S Eagle Rd Ste 1241
Meridian, ID 83642-6355
Phone: (208) 381-6930
Fax: (208) 381-6931
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 631 N Moonglow Ave, Kuna, ID 83634-2198 — (707) 666-1096

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 8871273 (ID)

Record details

NPI number1750074563
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 29, 2023
Last updated in NPPESOctober 15, 2025
Certification dateOctober 15, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Meridian