Healthcare Provider Details

I. General information

NPI: 1285367144
Provider Name (Legal Business Name): SCOTT CREPEAU APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W 650 N
LAYTON UT
84041-7553
US

IV. Provider business mailing address

3435 W 650 N
LAYTON UT
84041-7553
US

V. Phone/Fax

Practice location:
  • Phone: 951-833-3883
  • Fax:
Mailing address:
  • Phone: 951-833-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10898421-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: