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NPI Code Detail

MEDICARE: AUSTIN OKELBERRY PA

MEDICARE: AUSTIN OKELBERRY 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
1363A00000XPhysician Assistant9508539-1206UT

General Provider Information

NPI Number : 1902273311
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUSTIN OKELBERRY 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 : 801-831-2805
Fax Number :
Provider Business Practice Location Address
First Line : 4403 HARRISON BLVD STE 2455
Second Line :
City : OGDEN
State : UT
Zip : 84403-3330
Country : US
Telephone Number : 801-387-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2015
Last Update Date : 09/09/2021

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Directions to “ AUSTIN OKELBERRY PA” Practice Location

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