Provider Demographics
NPI:1558174318
Name:WORTHINGTON, JARED RICHARD (PA-C)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:RICHARD
Last Name:WORTHINGTON
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 1:12856 S SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7744
Mailing Address - Country:US
Mailing Address - Phone:801-712-3017
Mailing Address - Fax:
Practice Address - Street 1:12856 S SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7744
Practice Address - Country:US
Practice Address - Phone:801-712-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant