MEDICARE: ASHLYN HENRY PA

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	14291663-1206	UT

General Provider Information

NPI Number	:	1457142382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLYN HENRY PA

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9450 S 1300 E
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-5553
Country	:	US
Telephone Number	:	801-501-2112
Fax Number	:

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

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	06/08/2026

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Directions to “ ASHLYN HENRY PA” Practice Location

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