NPI age
19 years
Enumerated 2006-11-01
● Active
Type 1 · Individual
Charisse L MacK, PA
MacK is 1 of 363 physician assistant providers in Boise and 1 of 1263 in Idaho.
Primary specialty
Physician Assistant
Plus 1 subspecialty
Licensed in
ID
1 state
Status
Active
No deactivations on record
Last NPPES update
2013-03-04
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 1263 active physician assistant providers in Idaho.
NPI age
19 years
↑ 10 yr above median (9 yr)
State licenses
1 state
19% of peers hold multiple states
Subspecialties
1
In the 35% of peers with subspecialties
NPI lifetime · 2006 → 2026
2006-11Enumerated in NPPES
2006
2026
Where they practice
Practice location
6140 Curtisian Ave, Ste 400
Boise, ID 837048880
Mailing address
190 E Bannock St
Boise, ID 837126241
Specialties
-
Physician Assistant PrimaryA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally...
-
Physician AssistantDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 0214786 | STATE OF WA DOL |
| 01 (ID) | PAD65 | BLUE CROSS OF ID |
| 01 (ID) | 000010158697 | BLUE SHIELD OF ID |
| 05 (ID) | 807590500 |
Practice context
Part of a multi-provider practice. 17 other active providers share this practice address in NPPES.
Recently enumerated nearby: 3 new physician assistant providers have been added in Boise in the last 180 days.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.