=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346271715
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT L CARPENTER PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 11/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2965 W 3500 S
-----------------------------------------------------
City | WEST VALLEY CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84119-3602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-965-3600
-----------------------------------------------------
Fax | 801-965-3526
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12473 S MINUTEMAN DR
-----------------------------------------------------
City | DRAPER
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84020-7870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-495-7970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 53370601206
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 53370601206
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------