Healthcare Provider Details

I. General information

NPI: 1114402450
Provider Name (Legal Business Name): EARL JOHN WESTON DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N HARRISVILLE RD
HARRISVILLE UT
84404-3537
US

IV. Provider business mailing address

811 N HARRISVILLE RD
HARRISVILLE UT
84404-3537
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-1818
  • Fax:
Mailing address:
  • Phone: 801-399-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number79715554405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7971555-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: