Healthcare Provider Details

I. General information

NPI: 1497840987
Provider Name (Legal Business Name): LOYE WEST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 WEST MAIN STREET
GREEN RIVER UT
84525
US

IV. Provider business mailing address

202 NORTH 3980 EAST
RICHFIELD UT
84701
US

V. Phone/Fax

Practice location:
  • Phone: 435-564-3434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5350336-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: