Healthcare Provider Details

I. General information

NPI: 1225129976
Provider Name (Legal Business Name): TERI LYNN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 800 N STE 444
OREM UT
84057-6305
US

IV. Provider business mailing address

PO BOX 741729 CREDENTIALING DEPARTMENT
ATLANTA GA
30374-1729
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-6412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number266211-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: