Healthcare Provider Details

I. General information

NPI: 1003705765
Provider Name (Legal Business Name): LISA NICOLE HARDING PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA NICOLE WILLIS PMHNP

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 N ROBINS DR STE 300
LAYTON UT
84041-7077
US

IV. Provider business mailing address

2132 N ROBINS DR STE 300
LAYTON UT
84041-7077
US

V. Phone/Fax

Practice location:
  • Phone: 801-821-2781
  • Fax:
Mailing address:
  • Phone: 801-600-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12048911-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number12048911-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: