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

Mr. Tracy D. Mickelsen, CSFA

Individual provider Surgical Physician Assistant · NPI 1801073655

Mr. Tracy D. Mickelsen, CSFA is a Surgical Physician Assistant in Meridian, Idaho. Practices as a sole proprietor. Licensed in Idaho.

Licensed in
ID
In the registry since
2008

Practice location Address checks out

3015 E Magic View Dr
Meridian, ID 83642-3743
Phone: (208) 855-2410
Fax: (208) 482-5515
Show map & directions

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

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 178692 (ID)

Record details

NPI number1801073655
Entity typeIndividual (Type 1)
GenderMale
Credentials CSFA
Sole proprietorYes
NPI enumeratedJanuary 23, 2008
Last updated in NPPESDecember 7, 2017
Mailing address3015 E Magic View Dr, Meridian, ID 83642-3743

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