Individual
CONNOR JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(801) 884-7614
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2571593
ID
363A00000X
Physician Assistant
Primary
—
ID
Other
Enumeration date
10/28/2025
Last updated
02/11/2026
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