MEDICARE: MS. ALLISON MARIE ROBERTS

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		UT

General Provider Information

NPI Number	:	1720978208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLISON MARIE ROBERTS

Provider Business Mailing Address
First Line	:	30 N. MARIO CAPECCHI DRIVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112
Country	:	US
Telephone Number	:	801-581-6465
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N. MARIO CAPECCHI DRIVE
Second Line	:	HELIX, BLDG. 5050
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112
Country	:	US
Telephone Number	:	801-581-6465
Fax Number	:

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

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	03/24/2026

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