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

Jonathan D Nelson, PA-C

Individual provider Physician Assistant · NPI 1265882070

Jonathan D Nelson, PA-C is a Physician Assistant in Salem, Utah. Qualified in 2016, 10 years ago. Practices with Revere Health PC, a 410-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Utah and Wisconsin.

Years since qualifying
10
Licensed in
UT, WI
In the registry since
2016
Specialties on file
2
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

555 W Sr 164
Salem, UT 84653
Phone: (801) 465-4813
Fax: (801) 812-5433
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1055 N 500 W Ste 212, Provo, UT 84604-3305 — (801) 465-4813

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 10406360-1206 (UT)
Physician Assistant Taxonomy 363A00000X · Licence 3752-23 (WI)

Record details

NPI number1265882070
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 13, 2016
Last updated in NPPESNovember 27, 2023
Certification dateMarch 17, 2020
Mailing address1055 N 500 W, Attn: Credentialing, Provo, UT 84604-3305

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Revere Health Pc — 410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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