Healthcare Provider Details

I. General information

NPI: 1659936151
Provider Name (Legal Business Name): HEATHER HARRISON HARDY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12433 S FORT ST
DRAPER UT
84020-9363
US

IV. Provider business mailing address

12433 S FORT ST
DRAPER UT
84020-9363
US

V. Phone/Fax

Practice location:
  • Phone: 801-572-0828
  • Fax:
Mailing address:
  • Phone: 801-572-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number98046638900
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number98046634405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: