Active NPI
Lisa A.W. Griffin, PA-C
- Physician Assistant
- Provo, UT
National Provider Identifier
1891901179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 4737816-1206
- Practice address
- 1055 N 500 W
Suite 222
Provo, UT 84604-3305 - Phone
- (801) 377-4623
- Fax
- (801) 429-8150
- NPI assigned
- May 15, 2007
- Last updated
- Aug 14, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 4737816-1206 | UT | Primary |
Addresses
Primary practice location
1055 N 500 W
Suite 222
Provo, UT 84604-3305
Mailing address
1055 N 500 W
Credentialing Department
Provo, UT 84604-3305
Phone (801) 354-8225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4737816-1206 | UT | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218672000000",
"number": "1891901179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"address_2": "CREDENTIALING DEPARTMENT",
"city": "PROVO",
"state": "UT",
"postal_code": "846043305",
"telephone_number": "801-354-8225",
"fax_number": "801-429-8150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"address_2": "SUITE 222",
"city": "PROVO",
"state": "UT",
"postal_code": "846043305",
"telephone_number": "801-377-4623",
"fax_number": "801-429-8150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIFFIN",
"first_name": "LISA",
"middle_name": "A.W.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2008-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "4737816-1206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.