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NPI Code Detail

MEDICARE: MR. TY JOO MCCOMAS FNP-C

MEDICARE: MR. TY JOO MCCOMAS FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN-1854HI
2363LF0000XFamily Nurse Practitioner4917488-4405UT

General Provider Information

NPI Number : 1164813184
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TY JOO MCCOMAS FNP-C
Provider Business Mailing Address
First Line : 2240 ADAMS AVE
Second Line :
City : OGDEN
State : UT
Zip : 84401-1511
Country : US
Telephone Number : 801-393-5355
Fax Number : 801-394-4609
Provider Business Practice Location Address
First Line : 2240 ADAMS AVE
Second Line :
City : OGDEN
State : UT
Zip : 84401-1511
Country : US
Telephone Number : 801-393-5355
Fax Number : 801-934-4609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2015
Last Update Date : 02/03/2026

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