Healthcare Provider Details

I. General information

NPI: 1225064124
Provider Name (Legal Business Name): HEIDI PORTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 E 90 N STE 102
AMERICAN FORK UT
84003-2954
US

IV. Provider business mailing address

3550 N UNIVERSITY AVE STE 250
PROVO UT
84604-6695
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-9132
  • Fax: 801-756-5091
Mailing address:
  • Phone: 801-374-9625
  • Fax: 801-374-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number294278-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: