Healthcare Provider Details

I. General information

NPI: 1730748963
Provider Name (Legal Business Name): STEPHANIE HARRISON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE WALL HARRISON APRN, FNP-C

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 W 200 N
KAYSVILLE UT
84037-7900
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-383-3420
  • Fax: 801-383-3421
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6543804-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: