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NPI Code Detail

MEDICARE: JAMIE COY GRANGE PA-C

MEDICARE: JAMIE COY GRANGE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant95341561206UT

General Provider Information

NPI Number : 1528438140
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE COY GRANGE PA-C
Provider Business Mailing Address
First Line : 2245 N 400 E
Second Line : STE 301
City : LOGAN
State : UT
Zip : 84341
Country : US
Telephone Number : 435-753-7880
Fax Number :
Provider Business Practice Location Address
First Line : 2245 N 400 E
Second Line : STE 301
City : LOGAN
State : UT
Zip : 84341-1892
Country : US
Telephone Number : 435-753-7880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2015
Last Update Date : 06/24/2022

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Directions to “ JAMIE COY GRANGE PA-C” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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