Provider Demographics
NPI:1760132153
Name:EVERITT, JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:EVERITT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:1075 S HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647
Practice Address - Country:US
Practice Address - Phone:435-462-2044
Practice Address - Fax:435-462-2043
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14172263-1206363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical