Provider Demographics
NPI:1467934737
Name:HEWLETT, JUSTIN THOMAS (PA)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:THOMAS
Last Name:HEWLETT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5848 S FASHION BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6175
Mailing Address - Country:US
Mailing Address - Phone:801-314-4119
Mailing Address - Fax:801-314-4119
Practice Address - Street 1:310 N 850 E STE A
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-8623
Practice Address - Country:US
Practice Address - Phone:801-331-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant