MEDICARE: MRS. MACY RIDEOUT PARKIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	14242811-1206	UT

General Provider Information

NPI Number	:	1346945276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MACY RIDEOUT PARKIN

Provider Business Mailing Address
First Line	:	1353 S 2100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2272
Country	:	US
Telephone Number	:	385-630-5739
Fax Number	:

Provider Business Practice Location Address
First Line	:	1353 S 2100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2272
Country	:	US
Telephone Number	:	385-630-5739
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	03/09/2026

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Directions to “ MRS. MACY RIDEOUT PARKIN ” Practice Location

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