Healthcare Provider Details

I. General information

NPI: 1528483872
Provider Name (Legal Business Name): SEAN BRENT YOUNG FNP, CRNA/APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 N EAST PROMONTORY STE 230
FARMINGTON UT
84025-2995
US

IV. Provider business mailing address

PO BOX 109
KAYSVILLE UT
84037-0109
US

V. Phone/Fax

Practice location:
  • Phone: 801-698-9230
  • Fax:
Mailing address:
  • Phone: 801-698-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6163373-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6163373-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: