Individual provider Active NPI

Melanie Morrill Nelson, PA-C

  • Medical Physician Assistant
  • Bountiful, UT
National Provider Identifier
1124750096
Registry record updated Jun 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
13050486-1206 Issued in UT
Practice address
1551 Renaissance Towne Dr Ste 370
Bountiful, UT 84010-7675
Phone
(801) 965-3600
NPI assigned
Jun 28, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 13050486-1206 UT Primary
Physician Assistant 363A00000X 13050486-1206 UT

Addresses

Primary practice location

1551 Renaissance Towne Dr Ste 370
Bountiful, UT 84010-7675

Mailing address

2965 W 3500 S
West Valley City, UT 84119-3602
Phone (801) 965-3600

Other practice location 1

150 N Main St Ste 205
Heber City, UT 84032-1671
Phone (801) 965-3600

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
I20221230001144 UT Practitioner - Physician Assistant 4880064138 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Granger Medical Clinic PC 192 clinicians

Practice addresses (Care Compare)

12391 S 4000
Riverton, UT 84096-7012
Phone (801) 302-1700

2965 W 3500
West Valley City, UT 84119-3602
Phone (801) 965-3600

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Granger Medical Clinic PC CurrentSince Jan 8, 2024 Accepting new patients
Granger Medical Clinic PC CurrentSince Jan 8, 2024 Accepting new patients
After Hours Medical LLC, Dba Medallus Medical CurrentSince Dec 1, 2022 Accepting new patients
Granger Medical Specialists, LLC CurrentSince Aug 1, 2023 Accepting new patients
After Hours Medical LLC, Dba Medallus Medical CurrentSince Dec 1, 2022 Accepting new patients
Granger Medical Clinic PC PastSince Jun 18, 2023 Accepting new patients

Locations

1551 Renaissance Towne Dr
Ste 370
Bountiful, UT 84010
Phone (801) 292-4425

1126 E Draper Pkwy
Draper, UT 84020
Phone (801) 545-0600

8178 Gorgoza Pines Rd
Unit 8H
Park City, UT 84098
Phone (801) 747-7244

12391 S 4000 W
Riverton, UT 84096
Phone (801) 302-1700

995 W Levoy Dr
Taylorsville, UT 84123

7181 S Campus View Dr
Ste 200
West Jordan, UT 84084
Phone (801) 965-3505

2965 W 3500 S
West Valley City, UT 84119
Phone (801) 965-3505

Organizations & group practices 8

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

NPI Registry JSON

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780876800000",
    "number": "1124750096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193602",
            "telephone_number": "801-965-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 RENAISSANCE TOWNE DR STE 370",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107675",
            "telephone_number": "801-965-3600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 N Main St Ste 205",
            "address_purpose": "LOCATION",
            "city": "Heber City",
            "state": "UT",
            "postal_code": "840321671",
            "country_code": "US",
            "telephone_number": "801-965-3600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "MELANIE",
        "middle_name": "MORRILL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-28",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "13050486-1206",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "13050486-1206",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

Verify at the official NPI Registry.