Individual
HEATHER BENALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1055 N 500 W STE A, PROVO, UT 84604-3305
(385) 203-1250
(801) 812-5034
Mailing address
1055 N 500 W, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5655758-1206
UT
363AM0700X
Medical Physician Assistant
Primary
5655758-1206
UT
Other
Enumeration date
05/26/2006
Last updated
07/02/2026
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