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General NPI Number Information
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NPI Number | 1134198419
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Entity Type | Individual
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Provider Name | JARED A GREEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 1870 N MAIN ST STE 201
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City | CEDAR CITY
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State | UT
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Zip | 84721-7742
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Country | US
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Telephone | 435-383-9009
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Fax | 435-383-9010
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Provider Business Mailing Address
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Address Line | 1055 NORTH 500 WEST ATTN: CREDENTIALING
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City | PROVO
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State | UT
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Zip | 84604-3305
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Country | US
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Telephone | 801-354-8225
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Fax | 801-418-0941
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8441754-1206
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License Number State | UT
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