Healthcare Provider Details

I. General information

NPI: 1881453488
Provider Name (Legal Business Name): BRIAN PAUL MITCHELL PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 HERITAGE PK BLVD STE 230
LAYTON UT
84041-5636
US

IV. Provider business mailing address

735 E THREE FOUNTAINS CIR UNIT 47
MURRAY UT
84107-5249
US

V. Phone/Fax

Practice location:
  • Phone: 801-896-5345
  • Fax:
Mailing address:
  • Phone: 801-970-2676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11817116-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11817116-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: