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NPI Code Detail

MEDICARE: JUSTICE FARLEY

MEDICARE: JUSTICE FARLEY
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
1363A00000XPhysician Assistant12912309-1206UT

General Provider Information

NPI Number : 1417705831
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTICE FARLEY
Provider Business Mailing Address
First Line : 1800 NOVELL PL
Second Line :
City : PROVO
State : UT
Zip : 84606-6171
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1800 NOVELL PL
Second Line :
City : PROVO
State : UT
Zip : 84606-6171
Country : US
Telephone Number : 801-734-6769
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2024
Last Update Date : 01/12/2026

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Directions to “ JUSTICE FARLEY ” Practice Location

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