Individual
SUSANNA PARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
415 MEDICAL DR STE A100, BOUNTIFUL, UT 84010-4995
(801) 683-1062
Mailing address
148 N 360 W, CENTERVILLE, UT 84014-2139
(385) 226-1821
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14242213-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24796
BRPT
UT
Enumeration date
02/27/2023
Last updated
05/10/2026
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