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

Individual provider Surgical Physician Assistant · NPI 1013342468

Polina Kokoulina, PA-C is a Physician Assistant in Boise, Idaho. Qualified in 2013, 13 years ago. Practices with Saint Alphonsus Regional Medical Center Inc, a 673-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
13
Licensed in
ID
In the registry since
2013
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

900 N Liberty St Ste 101
Boise, ID 83704-8704
Phone: (208) 367-5050
Fax: (208) 367-5151
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA-1093 (ID)

Record details

NPI number1013342468
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 4, 2013
Last updated in NPPESApril 6, 2015

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Saint Alphonsus Regional Medical Center Inc — 673 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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