Healthcare Provider Details

I. General information

NPI: 1093338667
Provider Name (Legal Business Name): MIGNON BOYER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10342 N MORGAN BLVD
CEDAR HILLS UT
84062-8057
US

IV. Provider business mailing address

2501 STONEBURY LOOP RD
SPRINGVILLE UT
84663-3937
US

V. Phone/Fax

Practice location:
  • Phone: 801-310-1772
  • Fax:
Mailing address:
  • Phone: 801-310-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number11936914-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11936914-1206
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11936914-1206
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: