Healthcare Provider Details

I. General information

NPI: 1205770195
Provider Name (Legal Business Name): TRENTON JUDD STAPLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E 3000 N STE 130
CEDAR CITY UT
84721-7578
US

IV. Provider business mailing address

378 N 400 W APT A
CEDAR CITY UT
84721-4469
US

V. Phone/Fax

Practice location:
  • Phone: 435-590-2492
  • Fax:
Mailing address:
  • Phone: 435-590-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3854977
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: