Individual
REVINA TALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1478 EAST HIGHWAY 162, MONTEZUMA CREEK, UT 84511
(435) 651-3700
(435) 678-0608
Mailing address
PO BOX 130, MONTEZUMA CREEK, UT 84534-0130
(435) 651-3700
(435) 651-3376
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7132491-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000064825
MEDICARE PTAN
UT
Enumeration date
10/14/2008
Last updated
03/18/2022
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