Elizabeth J Avery, PA
Individual provider Active NPI Physician Assistant · Provo, UT
NPI 1134828965 · NPPES record last updated Sep 17, 2025
Key facts
- NPI
- 1134828965
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 14240564-1206 (UT)
- Practice address
- 1055 N 500 W
Ste 205, Building C
Provo, UT 84604-3305 - Phone
- (801) 429-8095
- Fax
- (801) 354-8265
- NPI assigned
- Mar 1, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Revere Health PC
Practice addresses (Care Compare)
1055 N 500
Provo, UT 84604-3305
Phone (801) 429-8095
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251126001632 | UT | Practitioner - Physician Assistant | 5496247496 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14240564-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revere Health PC | Current |
Accepting new patients | |
| Revere Health PC | Current |
Accepting new patients |
Locations
1055 N 500 W
Ste 205
Provo, UT 84604
Phone (801) 429-8095
1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 14240564-1206 | UT | Yes |
Addresses
Primary practice location
1055 N 500 W
Ste 205, Building C
Provo, UT 84604-3305
Mailing address
1055 N 500 W
Att: Credentialing
Provo, UT 84604-3305
Phone (801) 354-8226
Other names
- Elizabeth J Markle
Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.