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

Mrs. Mary Welborn, PA

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1699457754

Mrs. Mary Welborn, PA is a Physician Assistant in Boise, Idaho. Qualified in 2025, 1 year ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth.

Years since qualifying
1
In the registry since
2023
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

190 E Bannock St Fl 10
Boise, ID 83712-6241
Phone: (208) 381-5500
Fax: (208) 381-2555
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 11515 W Aldershot Dr, Boise, ID 83709-5559 — (208) 881-1183

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1699457754
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedAugust 7, 2023
Last updated in NPPESNovember 4, 2025
Certification dateNovember 4, 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
TelehealthOffers telehealth services
Practice locations5 on file with Medicare

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