Basic Information
| Provider Information | |||||||||
| NPI: | 1033671193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCK | ||||||||
| FirstName: | SKYLER | ||||||||
| MiddleName: | VANCE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 626 W MARIPOSA DR | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847802177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4352330248 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1380 E MEDICAL CENTER DR STE 1500 | ||||||||
| Address2: | |||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847902128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4352512500 | ||||||||
| FaxNumber: | 4352512525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2019 | ||||||||
| LastUpdateDate: | 01/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 11534759-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.