Healthcare Provider Details

I. General information

NPI: 1265013643
Provider Name (Legal Business Name): REBEKAH DRU JOHNSON DNP, FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2021
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 S MAIN ST
BOUNTIFUL UT
84010-6257
US

IV. Provider business mailing address

1546 VINEYARD DR
BOUNTIFUL UT
84010-1357
US

V. Phone/Fax

Practice location:
  • Phone: 801-683-9340
  • Fax: 801-992-1218
Mailing address:
  • Phone: 801-660-5645
  • Fax: 801-992-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1265013643
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number313830-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: