Healthcare Provider Details

I. General information

NPI: 1306320155
Provider Name (Legal Business Name): DARRYL HARDY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W 1700 S
CLEARFIELD UT
84016-6004
US

IV. Provider business mailing address

20 W 1700 S
CLEARFIELD UT
84016-6004
US

V. Phone/Fax

Practice location:
  • Phone: 801-416-4675
  • Fax: 801-416-4636
Mailing address:
  • Phone: 801-416-4675
  • Fax: 801-416-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number374487-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: