Provider Demographics
NPI:1336385707
Name:CHOATE, MELINDA (PA-C)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CHOATE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2356 N. 400 E.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074
Mailing Address - Country:US
Mailing Address - Phone:435-882-2350
Mailing Address - Fax:435-882-2039
Practice Address - Street 1:2356 N. 400 E.
Practice Address - Street 2:SUITE 201
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074
Practice Address - Country:US
Practice Address - Phone:435-882-2350
Practice Address - Fax:435-882-2039
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7201056-1205363AM0700X
UT7201056-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000065790Medicare PIN
UT000065790Medicare PIN