Healthcare Provider Details

I. General information

NPI: 1326860693
Provider Name (Legal Business Name): LEXADY BURKE LONGFIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 300 W STE 316
PROVO UT
84604-3373
US

IV. Provider business mailing address

1055 N 300 W STE 316
PROVO UT
84604-3373
US

V. Phone/Fax

Practice location:
  • Phone: 385-476-7830
  • Fax:
Mailing address:
  • Phone: 385-476-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12554501-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: