CMS-1500 Box 24J / 33a • NPI
1689008773
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
363LF0000X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family
Box 32 Service Location & ZIP+4
1680 W HIGHWAY 40 STE 202, VERNAL, UT, 84078
Official NPPES Practice Location
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1689008773 (ASHLEY VALLEY PHYSICIAN PRACTICE, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1689008773 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ASHLEY VALLEY PHYSICIAN PRACTICE, LLC |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family NUCC Code: 363LF0000X (Nurse Practitioner, Family) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 1680 W HIGHWAY 40 STE 202, VERNAL, UT, 84078 |
| Practice Telephone / Fax | Tel: (435) 781-3053 | Fax: (435) 781-3055 |
| Administrative Mailing Address | 330 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027-5098 |
| Enumeration & Last Sync | Enumerated: 2013-08-26 | CMS Record Updated: 2024-09-18 |
| Authorized Official | CHARLOTTE LAWRENCE (Secretary) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363LF0000X)
What Does Taxonomy Code 363LF0000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LF0000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ASHLEY VALLEY PHYSICIAN PRACTICE, LLC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
225X00000X — Occupational TherapistPlain English: Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab) | State: N/A | License: Verified | Primary: Secondary |
363LF0000X — Nurse Practitioner, FamilyPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family | State: N/A | License: Verified | Primary: Yes (Primary) |
363LX0106X — Nurse Practitioner, Occupational HealthPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Occupational Health | State: N/A | License: Verified | Primary: Secondary |
Medical Billing, RCM & Hospital Credentialing Teams:
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