Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1346972502 Individual Practitioner Female Practitioner

Breanna Bradley Black , PA-C

Physician Assistant • Provo, UT

Professional Overview & Biography Verified Profile Summary

Breanna Black, PA-C is a registered healthcare professional specializing in Physician Assistant in Provo, UT. Practice services are available at 1055 N 500 W BLDG A under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1055 N 500 W Bldg A

Provo, UT 846043305

Telephone 8018125033
Fax 8014180941
Associated Practice Facility / Clinic
🏢 No Roll Up Timpanogos Llc Facility NPI 1831153840

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Provo, UT

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.1 Yrs
State Avg: 12.1 Yrs
Regional Practice Density
147 Specialists

Practicing in Provo, UT (1904 Statewide)

Telehealth Adoption Rate
19.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2023-10-03
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License UT 13603008-1206

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Ashley Saunders

Nurse Practitioner - Family

NPI 1003680117
Michael Anderson , PA

Physician Assistant

NPI 1023569241

Physician Assistant

Maria Hoegh , APRN

Nurse Practitioner - Family

NPI 1053085050

Advanced Practice Registered Nurse

Dr. Wyatt Boles , DO

Family Medicine

NPI 1083190649

Doctor of Osteopathic Medicine (D.O.)

Elizabeth Larsen , APRN

Nurse Practitioner - Family

NPI 1093770562

Advanced Practice Registered Nurse

Amy Dalton

Nurse Practitioner

NPI 1104433606

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events
📍
Updated Practice Location October 03, 2023

Registered at 1055 N 500 W BLDG A, PROVO, UT 846043305 (Tel: 8018125033)

📍
Updated Business Mailing Address October 03, 2023

Registered at 1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 846043305 (Tel: 8013548225)

👤
Provider Name / Credentials Updated October 03, 2023

Recorded as BREANNA BLACK, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 03, 2023

Physician Assistant (License #13603008-1206 in UT)

NPI Profile Active June 27, 2022

NPI status registered as active in NPPES database

📍
Updated Practice Location June 27, 2022

Registered at 1341 S 1100 E, SPANISH FORK, UT 846605929 (Tel: 2082402967)

📍
Updated Business Mailing Address June 27, 2022

Registered at 1341 S 1100 E, SPANISH FORK, UT 846605929 (Tel: 2082402967)

👤
Provider Name / Credentials Updated June 27, 2022

Recorded as BREANNA BLACK

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 27, 2022

Physician Assistant

🟢
Initial NPI Registration & Enumeration June 27, 2022

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1346972502
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 27, 2022
Last Update: October 03, 2023
Sole Proprietor: No

Mailing Address

1055 N 500 W, Attn Credentialing

Provo, UT 846043305

Phone: 8013548225

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.