Healthcare Provider Details

I. General information

NPI: 1831325752
Provider Name (Legal Business Name): MICHAEL WILSON P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 W HIGHWAY 40
VERNAL UT
84078-2416
US

IV. Provider business mailing address

872 W HIGHWAY 40
VERNAL UT
84078-2416
US

V. Phone/Fax

Practice location:
  • Phone: 435-789-6677
  • Fax: 435-789-6678
Mailing address:
  • Phone: 435-789-6677
  • Fax: 435-789-6678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6739131-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6739131-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: