Healthcare Provider Details

I. General information

NPI: 1609769322
Provider Name (Legal Business Name): DRAKE THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 N DIGITAL DR
LEHI UT
84043-6651
US

IV. Provider business mailing address

1873 W TRAVERSE PKWY STE E100
LEHI UT
84048-5985
US

V. Phone/Fax

Practice location:
  • Phone: 801-215-9309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9464874-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: