Healthcare Provider Details

I. General information

NPI: 1669916664
Provider Name (Legal Business Name): CADE PRYOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 N 200 E
CEDAR CITY UT
84720-2615
US

IV. Provider business mailing address

474 W 200 N
ST GEORGE UT
84770-4505
US

V. Phone/Fax

Practice location:
  • Phone: 435-586-2515
  • Fax: 435-865-7606
Mailing address:
  • Phone: 435-634-5600
  • Fax: 435-634-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9861620-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: