Provider Demographics
NPI:1104506567
Name:JOHNSON, CADEN (PA)
Entity type:Individual
Prefix:
First Name:CADEN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E RIVERSIDE DR STE 160
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7604
Mailing Address - Country:US
Mailing Address - Phone:208-900-9500
Mailing Address - Fax:
Practice Address - Street 1:2025 E RIVERSIDE DR STE 160
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7604
Practice Address - Country:US
Practice Address - Phone:208-900-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant