Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

David Maurice Blackwell, PA-C

Individual provider Physician Assistant · NPI 1184867574

David Maurice Blackwell, PA-C is a Physician Assistant in Provo, Utah. Qualified in 2008, 18 years ago. Practices with Revere Health PC, a 410-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
18
Licensed in
UT
In the registry since
2009
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1055 N 500 W Ste 207
Provo, UT 84604-3305
Phone: (801) 375-4263
Fax: (801) 429-8085
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5505835-1206 (UT)

Record details

NPI number1184867574
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedApril 14, 2009
Last updated in NPPESNovember 27, 2023
Certification dateMarch 24, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Revere Health Pc — 410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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