Healthcare Provider Details

I. General information

NPI: 1285463737
Provider Name (Legal Business Name): JONATHAN ALLEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W 200 N
BRIGHAM CITY UT
84302-2109
US

IV. Provider business mailing address

5 W 200 N
BRIGHAM CITY UT
84302-2109
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-7999
  • Fax: 844-478-7580
Mailing address:
  • Phone: 435-723-7999
  • Fax: 844-478-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: