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

Jacob Church, PA

Individual provider Physician Assistant · NPI 1598495855

Jacob Church, PA is a Physician Assistant in Provo, Utah. Qualified in 2022, 4 years ago. Practices with Revere Health PC, a 410-clinician group, works from 2 locations and accepts Medicare assignment.

Years since qualifying
4
In the registry since
2022
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1055 N 500 W Ste 121
Provo, UT 84604-3305
Phone: (013) 737-3508
Fax: (801) 812-5401
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3000 N Triumph Blvd Ste 100, Lehi, UT 84043-4999 — (801) 763-3885

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1598495855
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedJune 10, 2022
Last updated in NPPESJune 10, 2022
Certification dateJune 10, 2022

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Revere Health Pc — 410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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