Provider Demographics
NPI:1457923815
Name:HALLMAN, BAILEY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:HALLMAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12427 S PASTURE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-4828
Mailing Address - Country:US
Mailing Address - Phone:801-727-8744
Mailing Address - Fax:801-727-8743
Practice Address - Street 1:12427 S PASTURE RD STE 104
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-4828
Practice Address - Country:US
Practice Address - Phone:801-727-8744
Practice Address - Fax:801-727-8743
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program