Healthcare Provider Details

I. General information

NPI: 1972979300
Provider Name (Legal Business Name): ANNELIESA ALLRED APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2297 N HILL FIELD RD STE 103
LAYTON UT
84041-6927
US

IV. Provider business mailing address

2019 S MOUNTAIN VIEW BLVD
WOODS CROSS UT
84087-2545
US

V. Phone/Fax

Practice location:
  • Phone: 385-888-9040
  • Fax:
Mailing address:
  • Phone: 801-361-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3083711-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3083711-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: