Healthcare Provider Details

I. General information

NPI: 1043125974
Provider Name (Legal Business Name): SAMANTHA WORRALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEBER STATE UNIVERSITY DEPT 3913
OGDEN UT
84408-3901
US

IV. Provider business mailing address

2810 S MELBOURNE ST
SALT LAKE CITY UT
84106-4042
US

V. Phone/Fax

Practice location:
  • Phone: 801-626-7210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14304170-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: