Individual
TYE FRANK JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
555 W SR 164, SALEM, UT 84653
(801) 465-4896
(801) 465-3267
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10701069-1206
UT
Other
Enumeration date
03/15/2018
Last updated
11/27/2023
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