Healthcare Provider Details

I. General information

NPI: 1992992952
Provider Name (Legal Business Name): TERRI LEE HOPKINS CLAWSON DHSC, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 04/07/2022
Certification Date: 04/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3674 W SOUTH JORDAN PKWY STE 223
SOUTH JORDAN UT
84009-7159
US

IV. Provider business mailing address

4638 W SERENDIPITY WAY
SOUTH JORDAN UT
84009-7730
US

V. Phone/Fax

Practice location:
  • Phone: 385-424-5527
  • Fax: 385-360-1616
Mailing address:
  • Phone: 385-424-5527
  • Fax: 385-360-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0756
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0069
License Number StateMP
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6731065-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: