Healthcare Provider Details

I. General information

NPI: 1346271715
Provider Name (Legal Business Name): SCOTT L CARPENTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 W 3500 S
WEST VALLEY CITY UT
84119-3602
US

IV. Provider business mailing address

12473 S MINUTEMAN DR
DRAPER UT
84020-7870
US

V. Phone/Fax

Practice location:
  • Phone: 801-965-3600
  • Fax: 801-965-3526
Mailing address:
  • Phone: 801-495-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number53370601206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number53370601206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: