IndividualActive
Tracy Mickelsen, CSFA
NPI 1801073655 · Surgical Physician Assistant · Meridian, ID
Provider details
- NPI number
- 1801073655
- Entity type
- Individual
- Primary specialty
- Surgical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- CSFA
- Sex
- Male
- Sole proprietor
- Yes
- License
- 178692 (ID)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
3015 E Magic View Dr
Meridian, ID 83642-3743
Phone: (208) 855-2410
Fax: (208) 482-5515
Approximate (ZIP-level) locationGet directions
Mailing address
3015 E Magic View Dr
Meridian, ID 83642-3743
Registry dates
- Enumerated
- 2008-01-23
- Last updated
- 2017-12-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.