Individual provider Active NPI

Shelly Poole Messerly, P.A.

  • Physician Assistant
  • Layton, UT
National Provider Identifier
1073868550
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
8209840-1206 Issued in UT
Practice address
2086 N Robins Dr Ste D
Layton, UT 84041-1164
Phone
(385) 515-4100
NPI assigned
Jul 19, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 8209840-1206 UT Primary

Addresses

Primary practice location

2086 N Robins Dr Ste D
Layton, UT 84041-1164

Mailing address

2086 N Robins Dr Ste D
Layton, UT 84041-1164
Phone (385) 515-4100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121113000771 UT Practitioner - Physician Assistant 0749431096 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Diabetes Relief Utah Ogden LLCGroup PAC ID 6709143381, 3 clinicians

Practice addresses (Care Compare)

2086 N 1700
Suite D
Layton, UT 84041-1164
Phone (385) 515-4100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
8209840-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Salsman Chiropractic Health Center Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1073868550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2086 N ROBINS DR STE D",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840411164",
            "telephone_number": "385-515-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2086 N ROBINS DR STE D",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840411164",
            "telephone_number": "385-515-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MESSERLY",
        "first_name": "SHELLY",
        "middle_name": "POOLE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-19",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "8209840-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Layton, UT

Sources for this page

Verify at the official NPI Registry.