Healthcare Provider Details

I. General information

NPI: 1093666455
Provider Name (Legal Business Name): STONE PUCKETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S MAIN ST STE B0001
BRIGHAM CITY UT
84302-6795
US

IV. Provider business mailing address

60 S MAIN ST STE B0001
BRIGHAM CITY UT
84302-6795
US

V. Phone/Fax

Practice location:
  • Phone: 435-239-8768
  • Fax: 435-921-5938
Mailing address:
  • Phone: 435-239-8768
  • Fax: 435-921-5938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF26-139474
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: