Healthcare Provider Details

I. General information

NPI: 1336385707
Provider Name (Legal Business Name): MELINDA CHOATE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA POWELL PA-C

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2356 N. 400 E. SUITE 201
TOOELE UT
84074
US

IV. Provider business mailing address

2356 N. 400 E. SUITE 201
TOOELE UT
84074
US

V. Phone/Fax

Practice location:
  • Phone: 435-882-2350
  • Fax: 435-882-2039
Mailing address:
  • Phone: 435-882-2350
  • Fax: 435-882-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7201056-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7201056-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: