Provider Demographics
NPI:1104077817
Name:CROWLEY, JAMES D (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:39 PROFESSIONAL WAY STE 1
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1676
Practice Address - Country:US
Practice Address - Phone:801-465-4805
Practice Address - Fax:801-465-4354
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT7127232-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7127232-1206OtherUTAH STATE LICENSE