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

Nathan Sanborn, PA

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1235861022

Nathan Sanborn, PA is a Physician Assistant in Salem, Utah. Qualified in 2022, 4 years ago. Practices with Revere Health PC, a 410-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
4
Licensed in
UT
In the registry since
2022
Specialties on file
2
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

555 W Sr 164
Salem, UT 84653-8465
Phone: (801) 465-4896
Fax: (801) 465-3267
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 13074268-1206 (UT)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1235861022
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedJune 29, 2022
Last updated in NPPESOctober 28, 2022
Certification dateOctober 25, 2022
Mailing address1055 N 500 W, Attn Credentialing, Provo, UT 84604-5015

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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