Provider Demographics
NPI:1811670904
Name:NIBLETT, SETH (PA-C)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:NIBLETT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 S 325 W
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9311
Mailing Address - Country:US
Mailing Address - Phone:435-890-4269
Mailing Address - Fax:
Practice Address - Street 1:395 S 325 W
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9311
Practice Address - Country:US
Practice Address - Phone:435-890-4269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty