Provider Demographics
NPI:1376553834
Name:HUNSAKER, TERYL RAY (PA)
Entity Type:Individual
Prefix:
First Name:TERYL
Middle Name:RAY
Last Name:HUNSAKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:TERYL
Other - Middle Name:
Other - Last Name:HUNSAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:435-716-1450
Mailing Address - Fax:
Practice Address - Street 1:1350 N 500 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2400
Practice Address - Country:US
Practice Address - Phone:435-716-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264667-1206363A00000X
UT2646671206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A631OtherAR BC/BS
ARP34388Medicare UPIN
AR5N289P131Medicare PIN