Healthcare Provider Details

I. General information

NPI: 1730140484
Provider Name (Legal Business Name): VANESSA EILEEN BEARD-ELY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 S COTTONWOOD ST STE 810
MURRAY UT
84107-5705
US

IV. Provider business mailing address

PO BOX 27128 ATTN: CREDENTIALING
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10000690A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9060898-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: