Healthcare Provider Details

I. General information

NPI: 1699159822
Provider Name (Legal Business Name): BRAUN TUELLER DMSC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 UNIVERSITY PARK BLVD
CLEARFIELD UT
84015-6283
US

IV. Provider business mailing address

PO BOX 65
LAYTON UT
84041-0915
US

V. Phone/Fax

Practice location:
  • Phone: 801-918-6038
  • Fax: 877-559-3988
Mailing address:
  • Phone: 801-918-6038
  • Fax: 877-559-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10121208-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number10121208-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: