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

Tanner D Mitton, PA-C

Individual provider Physician Assistant · NPI 1144601865

Tanner D Mitton, PA-C is a Physician Assistant in Blackfoot, Idaho. Qualified in 2012, 14 years ago. Practices with Wray Dermatology, a 3-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
14
Licensed in
ID
In the registry since
2015
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 →

Practice location Address checks out

1355 Parkway Dr Ste A
Blackfoot, ID 83221-1656
Phone: (986) 275-0003
Fax: (986) 275-0005
Show map & directions

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-1262 (ID)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1144601865
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 18, 2015
Last updated in NPPESJune 30, 2026
Certification dateJune 30, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Wray Dermatology — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Blackfoot