Healthcare Provider Details

I. General information

NPI: 1740475680
Provider Name (Legal Business Name): GAYLE ANN STOCKSLAGER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 S MAIN ST
LAYTON UT
84041-7135
US

IV. Provider business mailing address

934 S MAIN ST
LAYTON UT
84041-7135
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-7060
  • Fax: 801-336-1774
Mailing address:
  • Phone: 801-773-7060
  • Fax: 801-336-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number222078-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number222078-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: