MEDICARE: TODD MICHAEL CRAVENS PA-C

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	13246617-1206	UT

General Provider Information

NPI Number	:	1780268599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD MICHAEL CRAVENS PA-C

Provider Business Mailing Address
First Line	:	1055 N 500 W
Second Line	:	ATTN CREDENTIALING
City	:	PROVO
State	:	UT
Zip	:	84604-3305
Country	:	US
Telephone Number	:	801-354-8225
Fax Number	:	801-418-0941

Provider Business Practice Location Address
First Line	:	330 FALCON RIDGE PKWY STE 400A
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-8881
Country	:	US
Telephone Number	:	435-628-9393
Fax Number	:	435-628-9382

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

Provider Enumeration Date	:	05/07/2021
Last Update Date	:	03/20/2025

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