Healthcare Provider Details

I. General information

NPI: 1447725619
Provider Name (Legal Business Name): CHRISTY ANNE LOVELESS PA-C, MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 W 9000 S STE 240
WEST JORDAN UT
84088-8864
US

IV. Provider business mailing address

3590 W 9000 S STE 240
WEST JORDAN UT
84088-8864
US

V. Phone/Fax

Practice location:
  • Phone: 801-352-8373
  • Fax: 801-352-8459
Mailing address:
  • Phone: 801-352-8373
  • Fax: 801-352-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11004970-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11004970-1206
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number11004970-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: